Keywords: Health, Art, Science, Knowledge Domains, Medical model, Conceptual Framework, Care Domains
Citing this page:
Jones, P. (1998) Hodges' Health Career - Care Domains - Model, Nursing - Art or Science?
Since its foundation, as part of wider cultural trends nursing must constantly strive to integrate new knowledge and practices, which are often the product of other disciplines. Nursing is also simultaneously attempting to demarcate its own ontological corpus and boundaries. A process still on-going today in any registered nurse program and post-graduate courses. It is almost as if some nursing textbooks have nothing in them, and nurses are to be found reading the books of other disciplines, searching for their MIMER and professional recognition. This website may be symptomatic of this behaviour, as we often fail to see what we have. What we are. Too busy bandwagon jumping? This section explores the eclectic nature of nursing/health care knowledge and the reductionist / holist divide.
IN PURSUIT OF SCIENCE
There is much debate about the relationship of science, the scientific method and the associated concepts of facts, laws, theories and models. The way in which science is practised and scientific truths arrived at, the craft of the scientist - was considered critically by Ravetz (1971) and many other authors, who discuss the problems involved in the pursuance of scientific knowledge. In short science has its limitations. Western science is characterised by reductionist principles; but we reach a point at which the reduction becomes disassociated from the phenomena it is trying to explain. Medicine and health care generally is founded on scientific principles and has been subject to criticism for several decades more acutely since the 1960's.
Historically, the theoretical model suggested by Parsons (1951) to explain the doctor-patient relationship is based upon structural - functionalistic assumptions. In this model patients agree to surrender part of their normal autonomy, while the doctor agrees not to exploit the dependency of the patient. Information in the form of a history, signs and symptoms, is given by the patient to assist the doctor in pursuance of professional objectives. The doctor deals with this information only in professional terms. It should not affect him personally. Parsons is of course presuming that the necessary information is forthcoming. Szasz and Hollender (1956) modified this model as the inaccuracy in the proposed asymmetry of the relationship became apparent. Parsons presumes that there is patient co-operation; if the patient is suffering from delusions this co-operation may not initially be forthcoming. Alternately the patient and carer may be as knowledgeable as the doctor, either by virtue of their occupation and education or due to their medical condition, e.g., in diabetes.
As Archibald (2000) argues, a nursing model that allows care to be documented according to how it is developed, can be described as post-modern. But the inadequacy of the old dance partners - science and medicine - become ever more apparent when post-modern models are needed not just in nursing, but health and social care. While correct even this statement fails to capture the need for new approaches, methods and methodologies. Definitions are being challenged and former and current monopolies on what health is and who does what to whom and why are becoming starkly visible. Always acknowledged and much debated, but hidden by the facade of custom and practice, the sciences of the 21st Century - such as genetics - described by Taupitz (2000) leave no place to hide for anyone. Amongst several questions Taupitz poses what are 'health purposes' in respect of genetic tests?
© Peter Jones 2000
Archibald, G. (2000) A Post-Modern Nursing Model, Nursing Standard, May 10,14,34.
Johnson, D.E. (1980) Conceptual Models for Nursing Practice, Norwalk CT, Appleton-Century-Crofts.
King, I.M. (1981) A Theory for Nursing: Systems Concept Process, New York, John Wiley.
Neuman, B. (1982) The Neuman Systems Model: Application to Nursing Education and Practice, Norwalk CT, Appleton-Century-Crofts.
Orem, D. (1980) Nursing: Concepts of Practice, New York, McGraw Hill.
Ravetz, J.R. (1971) Scientific Knowledge and its Social Problems, Oxford, Clarendon Press.
Roper, N., Logan, W.W., Tierney, A.J. (1980) The Elements of Nursing, Edinburgh, Churchill Livingstone.
Sullivan, G.C. (1989) Evaluating Antonovsky's Salutogenic Model for its adaptability to Nursing, J. Adv. Nurs., 14, 4.
Szasz, T., Hollender, M.H. (1956) A contribution to the philosophy of medicine: the basic models of the doctor-patient relationship, Archives of Internal Med., 97: 585-592.
Taupitz, J. (2000) The conflict of understanding the genetic make-up
of man and his
Wainwright, P. (1999) The art of nursing, Int. J. of Nurs. Studies. 36:5,379-85.