After critique.
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Evaluation Studies as Topic↗
Biomedical subjects
G Rolfe
Publications and source records attributed to G Rolfe.
Postmodernism for healthcare workers in 13 easy steps.
Despite a growing literature on postmodernism in nursing and other healthcare disciplines, it continues to be dogged by mistrust, misunderstanding and outright hostility. Presenting the philosophy of postmodernism is a particularly difficult task, and most attempts fall into one of two traps: either the writer is a well-read and committed postmodernist in which case the writing tends to make too many assumptions about the background knowledge of the reader; or else the writer has only a passing knowledge of 'popular' postmodernism, in which case the writing often falls back on over-simplistic concepts which do not do justice to the issues and which are often completely misconceived. The problem is further compounded by the difficulty of writing about one discourse (I am using the word in its postmodern sense-all such 'jargon' is explained in the paper) from within a different and potentially hostile one. For the postmodernists, rational debate with their modernist colleagues is all but impossible, since (as we shall see) the logic and language of the dominant discourse of modernism rules out and refuses to acknowledge that of postmodernism (and vice versa). Postmodern texts therefore rely less on rational argument than on persuasive narrative and a deliberate subversion of many of the usual practices of writing. This introduction to postmodernism for healthcare workers attempts to straddle the two discourses in both its form and its content, and offers a mixture of argument, example and speculation.
Humans↗
One law for the lion and the ox.... A reply to Burnard and Hannigan.
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Humans↗
On not being clear: a response to Burnard.
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Communication↗
Fit for practice: Project 2000 student nurses' views on how well the curriculum prepares them for clinical practice.
This paper presents the findings from a small study, which compared student nurses' views on how well they felt the Project 2000 curriculum had prepared them for their first clinical placements. The views of two student nurse cohorts were obtained using a questionnaire developed for the purpose. The curriculum for the 'old' cohort allowed very little clinical time during the first 18 months and focused on academic classroom-based learning. The curriculum was subsequently restructured so that students on the 'new' curriculum experienced greater emphasis on practice and theory to practice links, and undertook their first clinical placement much earlier on in their course. Although statistical analysis of difference between the two cohorts suggests that students from the 'new' cohort felt they were better prepared, the actual differences in scores was small. The findings of this study provide only modest evidence of improvement in 'new' student nurses' views of how well they felt they had been prepared for their first placement.
Attitude of Health Personnel↗
Developing the role of the generic healthcare support worker: phase 1 of an action research study.
This paper reports on the first phase of an action research practice development project to explore, develop and evaluate the role of the generic healthcare support worker in a high dependency rehabilitation service. The project is being jointly conducted by staff from the University of Southampton, the University of Portsmouth and the Isle of Wight Healthcare NHS Trust and phase 1 is supported by a grant from the NHS Executive (South and West). The aim of phase 1 of the project is to explore the attitudes of staff towards the implementation of the role of the generic healthcare support worker, particularly regarding the practical, professional and ethico-legal problems of the role. Professional and support staff from different parts of the service were interviewed in groups and the interviews were tape recorded, transcribed and subjected to a simple thematic analysis. Four themes emerged from the data relating to the challenge to professional boundaries, being a generic worker, outcomes for service and patients and implementing the role. As an action research project, the aim was not to produce findings that are generalizable beyond the practice areas in which they were generated, but it is nevertheless hoped that the reader might be able to apply some of the conclusions to his or her own setting.
Attitude of Health Personnel↗
A fuzzy week for Nurse Der. Rolfian predilections?
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Humans↗
Insufficient evidence: the problems of evidence-based nursing.
Evidence-based medicine was first proposed in the early 1990s as a means of integrating clinical expertise with the best evidence from research. It has recently gained a foothold in nursing, where despite calls for a broad and nursing-oriented definition of what should count as evidence, it appears to be propounding the randomized controlled trial (RCT) as the gold standard. This paper challenges the wisdom of basing nursing practice on the findings of large-scale statistical research studies, and offers a number of logical objections to the underpinning philosophy of evidence-based nursing and the randomized controlled trial. It concludes by arguing for a rethinking of what should count as evidence, and suggests a quasi-legal model based on reflection rather than research, in which evidence is employed to understand and justify practice after the event rather than being used deterministically to plan practice in advance.
Clinical Competence↗
The pleasure of the bottomless: postmodernism, chaos and paradigm shifts.
In her paper Reconstructing Nursing: Evidence, Artistry and the Curriculum, Marks-Maran (1999) attempted to outline a new postmodern paradigm for nursing. Whilst I fully support this timely discussion of new insights into nursing theory and practice, Marks-Maran unfortunately presents a very idiosyncratic version of postmodernism which is both simplistic and, at times; inaccurate. My main concern, however, is with her assertion that postmodernism offers a new paradigm for nursing, since she misses the fundamental point that postmodernism is not a critique or replacement for the modernist paradigm, but a challenge to the very notion of paradigms. Rather than attempting to replace the modernist paradigm of nursing, then, postmodernism offers what Spivak called 'the pleasure of the bottomless' in which the perceived certainties of science are decentred and the authority by which all knowledge claims are made is questioned.
Humans↗
The theory-practice gap in nursing: from research-based practice to practitioner-based research.
The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research.
Humans↗
The marriage of heaven and hell: further remarks on the future for mental health research.
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Forecasting↗
The development and evaluation of the role of an advanced nurse practitioner in dementia--an action research project.
This action research project developed a new role of Advanced Nurse Practitioner (ANP) in dementia from first principles in response to the needs and requirements of the healthcare professionals already working in the service. In Phase 1 of the project, 42 workers were interviewed to determine their needs, hopes and fears of the role, from which a preliminary job description was constructed. In Phase 2, this role was implemented and continuously modified through regular reflective interviews with the ANP, resulting in some major changes to the original job description. In the final phase, the impact of the role was evaluated through interviews with patients who had used the new service, and questionnaires to the healthcare workers interviewed in Phase 1. The role that emerged from the project was therefore grounded in practice and proved to be an attractive proposition to the local healthcare trust.
Dementia↗
Writing ourselves: creating knowledge in a postmodern world.
In an attempt to encourage nurses and academics to write, there have been some recent journal papers that outline rules and guidelines for successful publication. This paper attempts to tackle the 'why' of writing rather than the 'how', and argues that writing is more than merely the representation of speech. Rather, writing is a creative act in which knowledge is produced as part of the process of writing itself, and at this level we might talk not merely of writing, but of writing. It is further argued that whereas the verb 'to write' always has an object (we write a book or an essay), the verb 'to write' is intransitive; it has no object. We do not write a paper, we merely write. We might, of course, choose to publish our writing, but it is done as an afterthought; we write for discovery, not for presentation. The act of writing is then compared to the act of teaching, and it is concluded that in order to teach, we must also write. Finally, this paper is offered as an example of writing (not an exemplar--there are as many ways to write as there are writers), and attempts to pull together material from a variety of sources including sociology, psychology, philosophy and literature as an act of discovery, of creating what I know about writing as I write.
Education, Nursing, Continuing↗
Science, abduction and the fuzzy nurse: an exploration of expertise.
Benner's work on expertise in nursing drew heavily on the writing of Dreyfus and Dreyfus in the field of computing. Dreyfus and Dreyfus argued that the continued failure of computer programmers to create an 'expert system', a program which could replicate the way that a human expert thinks, implied that experts do not think in a rational, analytic way. Dreyfus and Dreyfus therefore concluded that expertise is an intuitive process, and that 'the expert is simply not following any rules! He is ... recognising thousands of special cases'. Applied to nursing, this model of expertise has a number of profound implications for practice and education, and has been criticised for being elitist and deliberately obscure. This paper examines some recent innovations in computer logic, and argues that nursing can learn from a new breed of 'fuzzy' computer programmes which appear to be able not only to perform better than experts, but to verbalize their decision-making processes. By beginning to understand how experts think, it might be possible to develop expertise in a more controlled and logical way, thereby improving the practice of nursing.
Decision Making↗
Nursing praxis: a zealot responds.
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Nursing Faculty Practice↗
Beyond expertise: theory, practice and the reflexive practitioner.
This paper reconsiders Benner's book From Novice to Expert, in which the expert is portrayed as a reflective practitioner who works intuitively, drawing almost unconsciously on a repertoire of context-specific paradigm cases. In the light of more recent writings on informal, practice-based theory, it is suggested that there is a sixth level beyond expertise which is characterized by mindful practice and informal theory building. At this level, the practitioner constructs informal theory out of practice, applies that theory back into practice, and reflexively modifies the theory as a result of the changed clinical situation. Seen in this way, theory and practice are two parts of the same process, and the theory-practice gap is closed.
Clinical Competence↗