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To... 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. Lyotards 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 Nightingales work, which she never intended as a theory, and

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Peplaus 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.

Glazers 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. 200), 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

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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 nursings professional leaders
took this antagonist path to Western medicine, employing Foucault and others as
weapons, 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 Glazers case, to flashing signal lights and luminescent signposts of danger.
Almost nothing is said regarding the dangers of science, perhaps there just arent 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
professions 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.

OMathuna, D. P. (2004). Postodernism and nursing after the honeymoon. Journal
of Christian Nursing, 21(3), 4-11.

OMathuna begins by implying that Dan Browns 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 OMathuna 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, OMathuna doesnt 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
OMathuna states once you claim that Jesus Christ is the answer to anyone elses
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

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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 OMathuna 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 isnt even a good critique of postmodernism. I suppose that, for
OMathuna, 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 OMathuna 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, Lyotards 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

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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 todays pastiche is
tomorrows 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 Deweys phrase the epistemology industry, is that the
postmoderns 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 wouldnt 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, Rolfes point is not to defend the
diversity loving pluralists of qualitative research from the horde of positivist totalitarians
(read quatitativists) 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 Bhaskars 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

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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 Rortys famous
expression we dont 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,
Rolfes 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 (Bloors 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 Rolfes 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.

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While Traynors 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-Goobys, as well as, Kincheloe and McLarens critiques of postmodernism, the
former with respect to social policy and the latter qualitative research. Taynors 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 McLarens 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 Hartsocks critique of Foucault that Traynor really hits his stride.
From Hartsocks 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. 105), 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.

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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. 91) 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. 94). Glazer would indeed agree with both claims but
see the former as bad and the latter as good (even obvious) as would OMathuna as well

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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 Traynors 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 Nietzsches 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

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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-Franois Lyotard Michel Foucault, Gilles
Deleuze, Flix 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 were 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 isnt
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
postmodernists 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 Pickerings
language mangle that comes with it. As Deleuza and Guattari (1987) put it in reference
to arboreal culture (as opposed to rhizomatic) Were tired of trees. We should stop
believing in trees, roots, and radicles. Theyve 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]

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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.

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Clarke, L. (1996). The last post: Defending nursing against the postmodernist maze.
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