To… Comfort the Afflicted, Afflict the Comfortable

Comfort the afflicted, afflict the Comfortable A Selected Critical Annotated Bibliography of Postmodern Thought and Nursing By C. E. Betts Professor of Nursing Health Sciences McMaster University Hamilton, Ontario, Canada © 2007 – Granted we want truth: why not rather untruth? And uncertainty? Even ignorance? – The problem of the value of truth stepped before us – or was it we who stepped before this problem? – (Nietzsche, 1990, p. 33) Introduction:

Although most agree that “postmodern thought” begins with Nietzsche near the end of the nineteenth century, it was not until the middle of the twentieth that one witnesses the explosion of literature, criticism, art, culture, architecture, and virtually everything nameable discipline, that would make heavy use, willingly or not, of the term postmodernism. There are conflicting accounts as to the origin of the term, Toybee has been suggested as has Ihab Hassan, Federico de Onis, Fredic Jamison and no doubt others.

The answer to the question, who was it that first used the term is much less important than to what it was referring (it might well have been coined by several individuals independently and moreover each may have been characterizing a different phenomenon with it). However, this turns out to be a rather tricky affair to negotiate simply because the term has been used in so many ways, and to express so many different sentiments that it becomes difficult, if not impossible, to determine what it is, or what it means.

Lyotard’s famous, or infamous, “incredulity toward meta-narratives” hardly helps the work of clarifying. Nevertheless, its popularity, both in academic and popular culture, at the mid-point of the twentieth century was rather astounding (on the strength of such philosophers, writers and critics as Foucault, Deleuze and Guattari, Lyotard, Baudrillard, Derrida and others of course).

It represented for many a much needed emancipation from the ridged strictures of modernity, the stultifying effects of consumerism and mass culture and the alienation/oppression of late Capitalism. Coincidentally, or perhaps not so coincidentally, Hildegard Peplau the first contemporary nursing theorist, or at any rate the first to refer to her work as theory, (nearly a century had elapsed between Nightingale’s work, which she never intended as a theory, and Peplau’s Interpersonal Relations in Nursing which was published in 1952) began developing her ideas in the 1950s.

Following Peplau is a veritable cavalcade of theorizing, conceptualizing and philosophizing concerning nursing that continued through the latter half of the twentieth century, when postmodernism flourished (reaching its apogee perhaps with the Sokal Affair in 1996), and indeed into the early twenty-first, where postmodernism, as a coherent philosophy, appears to be in a relative decline. Perhaps then, as previously mentioned, it was no coincidence at all that contemporary nursing theory and theorizing emerged at the same time as postmodernism and continued to develop and diversify along with it.

If so, one is force to wonder what effect postmodernism has had on nursing as a discipline, both theoretical and applied. The purpose then of this assignment is to investigate the question, what is, or was, the effect of postmodernism on nursing. To address this aim I will examine 6 scholarly articles that deal specifically with postmodernism and its influence on, or relationship to, nursing. I will present an annotated bibliography that identifies, discusses and critiques these 6 papers. Glazer, S. (2001). Therapeutic touch and postmodernism in nursing: Nursing Philosophy, 2, 196-212.

Glazer’s preliminary target is therapeutic touch. As she tells it, Linda Rosa noticed that therapeutic touch was being offered to RNs as a valid practice of healing, that it was becoming popular as a continuing education course for nurses in Colarodo and moreover that it was sanctioned as such by the Colorado State Board of Nursing, despite, according to Glazer, having no research justification. This leads her to question “how have techniques steeped in [eastern] mysticism gained such a foothold in the nursing profession? ” (p. 197).

With that she also indentifies a correlation between the (growing) acceptance of questionable interventions and the attempt, by some nursing leaders and academics, to improve the professional status of the discipline with respect to scientific medicine. From this Glazer delineates “two very different roads to the goal of separate, equal professional status” (p. 199) with medicine; “Caring plus Science” and anti-science or “postmodern nurse theorists,” The former is simple it seems “traditional scientific methods and experimental designs to try to determine what kind of caring is most effective in helping patients. ” (p. 00), while the latter, the postmodern’s in nursing, according to Glazer, reject “reality,” the “objective,” “evidence-based practice,” “quantitative research,” and “even measurement” itself as “evil, patriarchal and insensitive.. modern science and modern medicine. ” Moreover, they “have discarded… causation and generalizability” (p. 200) which she sees as anathema to nursing (and indeed safe and effective health care practice). Glazer does not attempt to define postmodernism, which is just as well I suppose, instead she claims after reading Martha Rogers that “feels like an excursing into science fiction coupled with mysticism. (p. 198), unlike how a layperson feels after reading theoretical physics. As for Watson “[her] language often falls apart into free-floating poetic imagery, leaving the reader in a kind of New Age daze. ” (p. 202), as opposed, one might surmise, to the less mystical, though certainly every bit as disorienting, daze one gets from reading books and articles on quantum mechanics. She further accuses the postmodernists of using “an impressive-sounding array of philosophers” and “fashionable phrases” to make their case.

On the strength of a single episode of “healing touch” misuse gone wrong for a postpone liver biopsy patient Glaser opines “The danger is that there could be more incidents like this if nurses reject their biological training in favor of the new paradigm of faith. ” (p. 209), presumably scientific health care never makes mistakes of this kind or inadvertently causes suffering. Finally, she wonders “Could it be that nursing’s professional leaders took this antagonist path to Western medicine, employing Foucault and others as eapons, because their generation of women by and large could not become doctors? ” (p. 210). What one mostly learns from this article is that postmodern nursing is not scientific, or worse anti-scientific or, worst of all, hostile to science. This translates, far too easily in Glazer’s case, to flashing signal lights and luminescent signposts of danger. Almost nothing is said regarding the dangers of science, perhaps there just aren’t any, or at any rate the problems of an unquestioned scientism (by which I mean “science saves,” an Enlightenment belief that is no less faith based than religion).

The best that Glazer seems to do is to suggest that “Nurses make some good points about the medical profession’s tendency to overlook the emotional consequences of medical practice. ” (p. 203). There is little, if any, attempt to examine “medical practice” itself for untoward consequences, at both the individual and socio-cultural/socio-political levels. O’Mathuna, D. P. (2004). Postodernism and nursing after the honeymoon. Journal of Christian Nursing, 21(3), 4-11. O’Mathuna begins by implying that Dan Brown’s novel The Da Vinic Code and postmodernism have become immensily popular for similar reasons – distrust of authority.

He is rather scornful of “A philosophy [presumably postmodernism] that makes it easy for people to accept as true the blatanly false ideas in The Da Vinci Code… “ (p. 4). After dealing with Watson in the most supefical manner, as though she is bad for (nursing) business without having to seriously explian why, we come to the epiphany around which this offering is built. “The marriage of postmodernism and nursing has raised some eyebrows… But the honeymoon is over. ” (p. 5). We are then warned that “postmodernism will spread and become accepted before its implications are understood, resulting in serious consequences. (p. 5). In fact, much like Christianity I suppose. To be sure O’Mathuna does admit that neither science or medicine has been without problemtic consequences, nuclear weapons as an example of the former and “adverse effects” as well as “ethical dilemmas” for the latter. After sprinting through a discussion of postmodernism, which he essentially defines as a rejection of of the modern ethos “Progress is believed to arise from the rational application of the methods of science” (p. 6), we get to the “Future Directions, Detours ; Dangers” section.

This is a sprinkling of how “the postmodern hoax” has impacted alternative therapies, spirituality and ethics. With regard to spirituality, which discusses only Christianity, O’Mathuna doesn’t seem to know, or perhaps he has forgotten, that the philosophes of the Enlightenment ushered religion out the front door along with every other form of ignorance and superstition which is to say the whole of the non-scientific. Indeed, one could argue convincingly that it was postmoderism that opened the back door of modernity for it.

Thus when O’Mathuna states “once you claim that Jesus Christ is the answer to anyone else’s problems, or that the Bible contains absolute truth or that God is real whether you believe in him or not, you are making claims that postmodernism rejects” he just gets it absurdly wrong. What modernist would not reject the claim and at least the postmodernist is not looking for the same evidence the modernist would insist on. Finally after we are treated to a very brief critique of postmodernism that amounts to a critique of Gary Rolfe, we arrive at the O’Mathuna remedy.

Earlier he claims that “The excesses and dangers of science can be seen. These should be critiqued and corrected. ” (p. 9). One wonders why, given over 2000 years of western history, with some 400 of it seriously committed to science, no one has yet gotten around to finally doing that. In the end “we must walk as Paul did… [and seek] to understand the claims of postmodernism” and “deal with the physical realm,” which is a bit like saying we must think with Augustine and plan for the future. In any case this is hardly a fruitful way out of the postmodern aporia and I am pretty sure it isn’t even a good critique of postmodernism.

I suppose that, for O’Mathuna, if postmodernism and nursing insist on staying married after the honeymoon, it must be a marriage of some tension coupled with a respect and tolerance for difference. “We can learn from many of these ideas… we can dialogue with whom we differ so that we can earn the privilege of sharing the truth with them. ” (p. 11) – seems pretty postmodern to me. The value of this article as an address to the question; what is the effect of postmodernism on nursing is about the same as Glazer, with perhaps a little more intellectualism.

To be sure O’Mathuna is a somewhat more open to the possibility that the postmodern plague is not absolutely lethal. Kermode, S. ; Brown, C. (1996). The postmodern hoax and its effects on nursing. International Journal of Nursing Studies, 33(4), 375-384. I suppose the title of this paper lets the proverbial cat out of the authors’ critical bag. It begins with the standard overview of postmodernism, Lyotard’s rejection of grand narratives, discontent with the Enlightenment and all that that entails, the proclamation of, and at times with celebratory zeal for, multiple truths, diversity and pluralism.

Following this we are taken through a few pages of “Postmodernism and nursing” beginning with an admission by the authors that postmodernism might well seem appealing to a profession (nursing) traditionally subservient to another (medicine), with its “rejection of scientific objectivity and the celebration of the value of differing discourses. ” (p. 376). However, it is noted that there is no “tangible evidence” (presumably that means empirical) that postmodernism has had any effect on the “workplaces of practicing nurses. Following a quick treatment of some of the adherents or non-rejecters of, and general commentators on, postmodernism in nursing, we are treated to a list of “The characteristics of postmodernist influences on nursing…” (p. 377). “Rejection of positivism;” “Rejection of nursing models and metaparadigms;” “intersubjective research methodologies;” “avoid hegemonic forms of knowledge;” “stress intersubjectivity in patient care;” and “emphasise everyday life and ordinary [as opposed to grand narratives and comprehensive theory I assume]. ” (p. 377).

Finally we arrive at the “Problems with postmodernism. ” Postmodernism is cast initially as “merely a theoretical construct” associated with “the current mood of Western intelligentsia. ” Which essentially I take to mean that academics, intellectuals, professors and other generally leisured elites have become bored, jaded, disillusioned and what not with the traditions of discourse which descend from the Enlightenment, so much so in fact, that they have developed, created or invented a new discourse which is little more than schizophrenic pastiche. ‘Pastiche’ is the tendency for postmodernism to simply randomly cannibalize the styles of the past… [while] ‘schizophrenic’ qualities of postmodernism… provides a poignant metaphor. ” (p. 378). This is of course a familiar refrain, yet I am reminded of the outright rejection of Nietzsche by most of the analytic tradition in the first half of the twentieth century on similar grounds, that and madness I suppose. The problem, of course, with calling pastiche pastiche is that today’s pastiche is tomorrow’s profound thought.

There is though an important point that Kermonde and Brown do make in this section. “There is confusion between postmodernism as a description of ‘modern society’ with its breakdown… and the philosophy of postmodernism with its rejection of structures and belief in knowledge. ” (p. 378). It certainly bothers a lot of people that postmodernists make very little attempt to be prescriptive, to say nothing of foundational. Ignoring for a moment that this is rarely their purpose, prescriptions and foundations can certainly be critiqued without replacing them.

Moreover, the point of some criticism is to simply keep conclusions from closing too firmly. Nor does such and enterprise qualify as schizophrenic or pastiche. What really annoys, to use Dewey’s phrase “the epistemology industry,” is that the postmodern’s refuse to answer the question “what is better. ” Kermonde and Brown finally conclude, quite predictably, that the postmodern effect on nursing has been largely, if not completely, negative. They even suggest, similar to Glazer, that the motives of those accepting, or exploring, postmodernism in nursing are less than commendable.

That is, they “crave an epistemology which is unique to nursing. ” (p. 383), rather than, one must suppose, the work of intervening toward better health, better lives and a better society for individuals. Indeed, the rejection of grand narratives, according to Kermonde and Brown, renders the “social significance” of nursing “minuscule. ” Moreover, “Capitalism, patriarchy and power persevere in ignorance of postmodernist musings. ” (p. 383). These are, of course, old school Enlightenment values and that they are questionable simply escapes Kermonde and Brown.

Rolfe, G. (2006). Judgements without rules: Towards a postmodern ironist concept of research validity. Nursing Inquiry, 13(1), 7-15. It just wouldn’t be fitting to ask the question; what has the postmodern effect been on nursing, without referring to Gary Rolfe, perhaps the premier postmodern trouble maker currently contributing to the debate in the literature. He begins the paper with an overview of the postmodern – modern debate and then quickly morphs it into the quantitative-qualitative issue.

Interestingly though, Rolfe’s point is not to defend the diversity loving pluralists of qualitative research from the horde of positivist totalitarians (read quatitativist’s) this time around. Rather, it to set this binary within a greater postmodern discourse of validity, or in this case legitimacy. As he puts it “… this paper explores the question of the criteria (or lack of them) that the postmodern reader might employ in deciding whether or not to accept the findings and conclusions of a research report. ” (p. 8).

Rolfe cites Bhaskar’s differentiation of “judgemental and epistemic relativism,” the former being the Feyerabendian “anything goes” types and the latter being the Rortian “ironists. ” This is to say epistemic relativists, who Rolfe appears to support, recognize the need to “continue to make judgements and distinctions, but who reject the modernist criteria on which they are made. ” (p. 8). After demonstrating why each faction deserves the term relativist, we are encouraged, with the help of Rorty, to view the “epistemic relativists” ironist position as procedural relativism rather than their more radical (less judgemental in fact) cousins.

One is reminded of Rorty’s famous expression “we don’t need to be so open minded that our brains fall out. ” Essentially, the ironists posit, according to Rolfe, that “not all judges are equally equipped to make claims about the validity or truth of the research. ” (p. 12). The more qualified are those who have significant procedural and practical experience. “Just as nursing practice can only be evaluated and critiqued by experienced nurses, so research practice can only be evaluated and critiqued by experienced researchers. ” (p. 12).

The point is that discrimination with respect to validity requires some technical experience with the method and procedure being used, and presumably by extension, some knowledge of the context or field of the research question being proposed. Where Rolfe seems to have gotten off track, or at any rate lost some perspective, is his comparison of “the rules of chess” to the rules of science. Just as the rules of chess have “no meaning outside… the game,” he suggests, so the rules of science have “no meaning outside the game of science. ” (p. 11).

While there might well be something to this for a postmodernist, Rolfe’s use Lyotard, that “science is authoritarian rather than authoritative” (p. 11), is a gross simplification and the analogy he uses to get there is shaky at best. I might agree that “The authority of science derives not from epistemology, but from power and politics” (p. 11), however, this does not mean that “the authority” is without any standing of its own, nor dose it mean that it is epistemological. For example, Rolfe takes great pains to imply and at times explicitly state that, “all attempts at validation are personal and subjective. (p. 11). This ignores a great deal of philosophy of science that is, strictly speaking, not epistemology (Bloor’s Strong Programme comes to mind for one), yet neither is it grounded in only the “personal and subjective. ” It also misses the possibility, Harry Collins as an example or even Steven Fuller of Social Epistemology fame, that the authority, or grounds, for validation might well be social rather than just “personal and subjective. ” The point to be made is that the social value of chess hardly compares with the potential social value of science.

While I agree that nothing can be said about Truth, or even “the right” practice, a scientific method can certainly suggest better directions and procedures based upon a social valuation. Put differently, if a desired goal for a given group of people (ie. the cure of a disease safely) is delineated than the resultant finding of a method can be validated in that the method used has demonstrated the possibility of attaining that goal. Moreover, surely it is possible, using scientific methods, to effectively rule some approaches out, which is to say that they will not result in the valued, goal.

In the end Rolfe provides no more grounds for choosing a set of findings than anyone else. To be sure, I choose this because I am an expert, but I am being ironic about it, hardly works beyond the abstruse theory level of thinking. There is something to be said for Rolfe’s use of Rortian irony and its application to nursing but it might well deteriorate quite quickly into little more than expertism, which is surely something that every postmodernist wants to be critical of. Traynor, M. (1997). Postmodern research: No grounding or privilege, just free-floating trouble making.

Nursing Inquiry, 4, 99-107. While Traynor’s purpose in this paper is similar to innumerable others “this paper attempts to mark out some of the main positions that have been taken” with regard to the modernist/postmodernist debate, it also adds an interesting and frankly refreshing twist. As the title implies, Traynor is particularly taken with the use of postmodern critique as intellectual trouble making. Yet he also disavows any emancipatory claims made in the name of postmodernism, which is precisely one of the chief reasons many reject it. Now here we have something interesting indeed.

But why make trouble for, what appears, to be the sake of making trouble? Prior to addressing this Traynor provides a, better than average, overview of the debate, or perhaps internecine. Next is a very brief critique of Taylor-Gooby’s, as well as, Kincheloe and McLaren’s critiques of postmodernism, the former with respect to social policy and the latter qualitative research. Taynor’s views are thus respectively “Taylor-Goddy cannot but adopt an unquestioned Enlightenment language [with its’] high quality objective knowledge that can be deployed in social planning. (p. 101), and “What is disconcerting about Kincheloe and McLaren’s view… is the epistemological confidence with which they argue their case. ” (p. 101). I should mention that Traynor wisely notes, in the work of Kincheloe and McLaren, the important issue of differentiating between postmodern culture, or postmodernity, and postmodern thought, or postmodern theory. Indeed they are not the same thing and just how and why they are connected is a debatable affair.

The problem perhaps, and it is common in the nursing literature, is the assumption that if one critiques away at a foundation, one must replace it with something, which is no doubt good policy when it comes to buildings and bridges, but not necessarily philosophical and intellectual criticism. It is during his rendering of Nancy Hartsock’s critique of Foucault that Traynor really hits his stride. From Hartsock’s perspective, we are told, “Foucault fails to give any basis for resistance… we would in effect be exchanging one discursive identity for another, and in doing so create new oppressions. (p. 102). Traynor then makes the astute point that it is possible to not only view nursing as oppressed “by managers, the medical establishment and male epistemology” but also as having “domination over the patient or other healthcare workers, using many of the same technologies of power. ” (p. 102). This then opens up a critical space to investigate and explore ways that groups or individuals might well be “complicit in their own domination” as well as party to the domination of others. Traynor then explicates “an agnostics of undecidability” (p. 05), a very promising, and to be sure appealing, use of terminology. The general idea here is that any articulated position (for example; nursing is an oppressed group of individuals) takes its place beside other, different and perhaps incommensurate though not necessarily so, positions (for example; nursing is an oppressive group of individuals). In an important sense then, there is no absolute foundation for any claim, but rather a brand of discourse that leads to a conclusion and with that other brands of discourse that lead to other conclusions.

This does nothing of course to ameliorate the modernist/postmodernist separation, however what Traynor has done, in an impressive fashion, is to add in to the cycle a trouble making agent whose purpose is to prevent conclusions for closing tight and concretizing. Ok nursing is oppressed, but they are also oppressing others as well and moreover contributing to their oppression by subjectively, and perhaps even wilfully, “occupying positions constituted as self-sacrificing. ” (p. 105). In order to escape the modernist bellicosity of relativism Traynor, in a similar manner as Rolfe, defers to Richard Rorty. As Rorty acknowledged, even though there may be no non-circular justification for doing what we do, this does not prevent us from arguing our case with passion. ” (p. 106). For Rorty after all the game is not foundation, truth, accuracy or even justification, but – persuasion. Traynor then presents a compelling argument for an all too important effect, or potential effect, of postmodernism on nursing – “create trouble for those who are, at this particular period, having their say. ” (p. 106). It is important to note that Traynor is not advocating a thoughtless, random, anarchistic attack at all.

Rather he suggests just the opposite, a serious and careful examination that simply asks can it be otherwise or perhaps even should it be otherwise. Indeed if those who are having their say fold at the first sign of a troubling critique, perhaps one should wonder if their say has any substance to it at all. Holmes, C. A. ; Warelow, P. J. (2000). Some implications of postmodernism for nursing theory, research and practice. Canadian Journal of Nursing Research, 32(2), 89-101. The work of Holmes and Warelow follows nicely from that of Traynor.

They set the stage for their efforts by clearly delineating their target. “The dominant view assumes that the universe is a system that yields its truths through careful observation and analysis, that the knowledge thus acquired is universal, singular, and constructive, and that our practices are shaped by, and aspire to, the ideals these imply. ” (p. 89-91). As incredible as it may seem, our culture (Western that is) still functions by and large with this as its foundation and what is more astounding is that a significant number of intelligent and educated individuals believe it (some religiously).

Holmes and Warelow aim to “outline some postmodern challenges. ” They begin by citing the standard line, though in this version there is no Lyotard, incredulity and meta-narratives (Lyotard shows up later) “postmodernists reject, to varying degrees, the traditional monolithic notions of truth and rationality, in favour of pluralistic ways of knowing. ” (p. 90). With regard to nursing theories then Holmes and Warelow see “postmodernist features in Rogers, Newman, and Sarter, although it is acknowledged that they are actually – modernist grand theorists.

Likewise Benner gets the label “postmodernist flavour” in that she is concerned with “purely local understandings. ” Holmes and Warelow clearly view nursing theory as a modernist enterprise and castigate those who are “critical of traditional polarities” for “[continuing] to be bewitched by universalism and the obstinately cherished illusion of a grand theory. ” (p. 91). They chastise Packard and Polifroni and their well know paper The dilemma of nursing science: Current quandaries and lack of direction for “[bemoaning] the resulting confusion, lack of consensual aims, and inconsistencies in the definition of nursing” (p. 1) as well as the defence of “pure science” in nursing. After some discussion and a few long lists of things postmodernists dislike we come to, what appears to be, a postmodern rejection of grand theories in general. There is also the suggestion that a certain epistemological disillusionment is “leading nurse theorists ever nearer to a postmodernist antiphilosophical position. ” (p. 93). Moreover, they cite Afaf Meleis’ well known “get off.. the [theoretical] bandwagon… and on with the… business of nursing” refrain as something which “many nurses will sympathize with. ” (p. 4). Glazer would indeed agree with both claims but see the former as bad and the latter as good (even obvious) as would O’Mathuna as well as Kermode and Brown. Traynor would likely view it as problematic and to their credit Holmes and Warelow have the foresight to see it as potentially “both liberating and dangerous. ” Perhaps their treatment of nursing research and postmodernism can be summed up by noting the (familiar) binaries mentioned by the authors; on the traditionalist side, objectivity, replicability, and value-free, and on the postmodern side, no, no and no.

This is to say; dehumanizing, decontextualizing, value laden respectively. Like Traynor’s trouble making, Holmes and Warelow believe that “there is desperate need for deconstructive analyses [that] create novel, disturbing variations, disrupting, fragmenting, and destabilizing existing [language] games. ” (p. 96). No doubt a horde of critics would not call this research, however it seems that Holmes and Warelow would, and I would likely agree. Finally, the paper presents “six postmodern suggestions [for] re-visioning nursing practice. ” (p. 97).

These are: experience and insights of practitioners over what they term “armchair theorists; “expose underlying metanarratives” for the purpose of “disrupting and undermining the existing discourse;” reject “universals, absolutes, and dichotomies” in favour of “creative and fruitful discourse”; abandon “traditional notions of illness and wellness” and with that revise “notions of treatment, care, and cure;” and finally, deconstruct (both in the building sense and in the philosophical sense) boundaries (nurse/non-nurse, patient/non-patient etc) and “accept tensions, discontinuities, and differences… clinical, ethical, relational, and political. ” Although they are unlikely to change any minds with these suggestions, and to be sure each is problematic in a modern world (which is where we still are) they certainly do convey the spirit of postmodernist thought. Finally, no problems will be solved by imbibing this call for ambiguity, but, again, that does make them postmodern. Conclusion: There seems little doubt that postmodernism, again that school of thought that originates with Nietzsche’s radical perspectiveism, but coming to fame in the mid-twentieth century, has had an effect on nursing, perhaps even a profound effect.

Whether or not such an effect can be demonstrated at the level of the practicing nurse remains to be seen. Certainly we can likely suggest that the postmodern movement has affected most, if not, all individuals that work, live, reproduce and play in the western world and in so doing has exerted an effect on nurses and hence nursing indirectly. For example, there will be little disagreement with the claim that our culture (North America in particular) has become more relativist in many respects. However whether or not this is as a result of postmodernism or a changing modernity is open to interpretation. The value of the effect of postmodernism on nursing is, quite predictably, predicated on what one thinks of postmodernism.

What I have done here is to review three articles that admit a significant influence of postmodernism on nursing but that generally view that influence as negative, and three that claim positive effects. With regard to the negative, the essential objection is that the postmodern propensity to reject large things (grand narratives, hegemonic discourse, singular conceptions, generalized answers, to say nothing of Truth, Right, Universal etc) and instead argue for contestable particulars set within profound complexity, denies any stable ground from which to intervene (for the better) in the lives of individuals, families, cultures and societies. While this is certainly a legitimate critique it requires an explanation of what for the better means. Moreover, a postmodernist might not only question this, but ask, what it means to intervene.

Perhaps the most important point to be made to those who harbour these, quite legitimate, concerns is this; I am not aware of any postmodernist who argues that we should not intervene because we have no foundation for doing so. Indeed, who would not argue that intervention is unavoidable by the very virtue of being human? Rather they suggest, as I read them at any rate, that all intervention has side effects and, to complicate matters further, there are also side effects of side effects. As Beck and Lau (2005) put it in their theory of Second, or Reflexive, Modernity (as opposed to Postmodernity) “… it can be assumed that processes of change and transformation in particular parts of the structure will trigger problems in other parts (the side effects of side-effects), exposing the entire structure of society to the pressure of change. ” (p. 533).

Those trouble makers then, who see value in radical critique, might be seen as insisting upon a careful examination of these side effects. Given that nurses understand the language of side effects well, perhaps this will be more palatable? After all, is there anyone who would argue that we ignore the side effects, and potential side effects, of our individual and collective activity for the safety and comfort of secure and stable foundations? Moreover, I know of no one who claims that practicing nurses must read Jean-Francois Lyotard Michel Foucault, Gilles Deleuze, Felix Guattari, Jean Baudrillard, Jacques Derrida, Georges Bataille, or even Luce Irigaray, Paul Virilio, Stanley Aronowitz, Julia Kristeva and others as a matter of reflective practice.

However, a scrutiny of our procedures, actions, judgements and interventions for the exclusion and suffering they might be causing while we’re busy preaching inclusion and (presumably) reducing suffering, seems a profoundly important task. And anyone who thinks that science, techno-rationality, instrumental reason, liberal democracy, secular systems of justification and justice, drives to efficiency, free market economics, bureaucratic institutionalism and to be sure even the very notion of capital “P” progress (all Enlightenment ideas that were intended to make the lives of people better at one time or another) are not causing, and have not caused, suffering, simply isn’t thinking at all.

To be sure, much of postmodernism might legitimately be ignored (for the time being anyway) just as much of Nietzsche, its central prophet in many respects, should certainly be ignored (the will to power perhaps? ). This does not however de-legitimate the method of critique for the sake of critique, nor does it mean “the real world” so called, should be ignored simply because a group of discontents have critiqued tunnels and holes in it without filling them in with a substantive materialism. For those who would argue that enough tunnels and holes might well cause a structure to collapse I would submit that yes it would, but collapse into what is the question. Indeed, all things collapse, or perhaps it is better worded – change. And as previously mentioned, the postmodernist’s refusal to answer this question is what is most irksome to many.

However, to put it bluntly, I have little time for those thinkers, writers, researchers or critics who insist on diversity yet complain about the mess, or to use Andrew Pickering’s language “mangle” that comes with it. As Deleuza and Guattari (1987) put it in reference to arboreal culture (as opposed to rhizomatic) “We’re tired of trees. We should stop believing in trees, roots, and radicles. They’ve made us suffer too much. All of arborescent culture is founded on them, from biology to linguistics. ” (p. 15). In other words, it might well be diversity all the way down. Hence, the other side of whether or not the postmodern effect is good for nursing claims that critique (of what is assumed) is essential, even radical critique.

This matter is all the more pressing in that “[Nurses] contribute to social regulation through a vast array of diverse political technologies… They occupy a strategic position that allows them to act as instruments of governmentality… making use of disciplinary technologies and responding to state ideologies. ” (Perron, Fluet and Holmes, 2005, p. 536). And if such radical critique results in trouble making – so be it, in fact – bring it on. Other Works Consulted Aranda, K. (2006). Postmodern feminist perspectives and nursing research: A passionately interested form of inquiry. Nursing Inquiry, 13(2), 135-143. Beck U. ; Lau C. (2005) Second modernity as a research agenda: Theoretical and empirical explorations in the ‘meta-change’ of modern society. British Journal of Sociology 56(4), 525–557. Clarke, L. (1996). The last post: Defending nursing against the postmodernist maze. Journal of Psychiatric and Mental Health Nursing, 3, 257-265

Deleuza, G. ; Guattari, F. (1987). A thousand plateaus: Capitalism and schizophrenia. (tr. by B. Massumi). University of Minnesota Press, Minneapolis. Francis, B. (2000). Poststructuralism and nursing: Uncomfortable bedfellows? Nursing Inquiry, 7, 20-28. Holmes, D. ; Gastaldo, D. (2004). Rhizomatic thought in nursing: An alternative path for the development of the discipline. Nursing Philosophy, 5, 258-267. Lister, P. (1997). The art of nursing in a ‘postmodern’ context. Journal of Advanced Nursing, 25, 38-44. Lister, P. (1991). Approaching models of nursing from a postmodern perspective. Journal of Advanced Nursing, 16, 206-212. Marks-Maran, D. (1999).

Reconstructing nursing: Evidence, artistry and the curriculum. Nurse Education Today, 19, 3-11. Nietzsche F. (1990) Beyond Good and Evil Prelude to a Philosophy of the Future (tr. R. J. Hollingdale). Penguin, New York. Perron, A. , Fluet, C. ; Holmes, D. (2005). Agents of care and agents of the state: Bio-power and nursing practice. Journal of Advanced Nursing, 50(5), 536–544 Rolfe, G. (1999). The pleasure of the bottomless: Postmodernism, chaos and paradigm shifts. Nurse Education Today, 19, 668-672. Rolfe, G. (2005). The deconstructing angel: Nursing, reflection and evidence based practice. Nursing Inquiry, 12(2), 78-86. Stajduhar, K. I. , Balneaves, L. ; Thorne, S. E. (2001).

A case for the ‘middle ground’: Exploring the tensions of postmodern thought in nursing. Nursing Philosophy, 2, 72-82. Stevenson, C. ; Beech, I. (2001). Paradigms lost, paradigms regained: Defending nursing against a single reading of postmodernism. Nursing Philosophy, 2, 143-150. Thompson, J. L. (2002). Which postmodernism? A critical response to ‘theraputic touch and postmodernism in nursing’. Nursing Philosophy, 3, 58=62. Walker, C. A. (2005). Postmodernism and nursing science. The Journal of Theory Construction and Testing, 9(1), 5. Watson, J. (1995). Postmodernism and knowledge development in nursing. Nursing Science Quarterly, 8(2), 60-64.