Society, Culture

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Society, Culture Nursing- Delivery of Health
Care

• By Dr David Lee
• VUT - Sunbury
• 2001

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What is Science?

• Science is a systematic attempt to establish
  theories to explain observed phenomena and the
  knowledge obtained through these efforts

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What is Science?

• Observations
• patterns
• Hypothesis
• Experiment
• reject hypothesis ltgt support
  hypothesis
• 
  
• start all over again
  theories

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What is Science?

• 2 types
• 1. Pure science is concerned with the gathering
  of information solely for the sake of obtaining
  new knowledge

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What is Science?

• 2. Applied science is the practical application
  of scientific theory and laws

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What is Science?

• Scientists support the view
• All things could be explained by a sequence of
  cause and effect and verified by objective
  experimentation

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Beliefs of Science

• Pure objectivity is possible
• Facts are fundamental. The world can be viewed as
  value neutral
• Everything can be measured
• Research is conducted along experimental lines

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Challenges of scientific beliefs

• Pure objectivity
• Many human situations where objectivity may not
  be possible, e.g. marking your essay

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Challenges of scientific beliefs

• 2. Facts are fundamental. The world can be viewed
  as value neutral
• Violence against women is researched and facts
  and figures collected but the underlying
  moral/societal issues remain unaddressed

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Challenges of scientific beliefs

• 3. Everything can be measured
• Nurses can measure vital signs but how can one
  measure caring?

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Challenges of scientific beliefs

• 4. Research is conducted along experimental
  lines
• What about the ethics applied to human
  experiment?

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Assumptions of science

• All things can be reduced to the sum of their
  parts
• Objectivity is emphasised
• Not valid when it can not be quantified
  (measured, observed, tested and generalised)

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Challenges of scientific assumptions

• All things can be reduced to the sum of their
  parts
• A motor mechanic can dismantle a motor, find the
  fault, and put it all back together again. How
  does this relate to child abuse?

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Challenges of scientific assumptions

• 2. Objectivity is emphasised
• Caring, empathy and intuition are essential to
  nursing practice but these subjective elements
  are under-valued by science

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Challenges of scientific assumptions

• 3. Not valid when it can not be quantified
  (measured, observed, tested and generalised)
• The most powerful individual human experiences
  death, grief, guilt cannot be generalised and
  measured

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Functions of science

• To separate scientific knowledge from that which
  is considered common or everyday knowledge
• To help identify truths and to prove theories

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Functions of science

• To justify the view that knowledge which is
  scientific is valuable (most nursing knowledge
  does not satisfy this criterion)
• To explain phenomena in the world today war,
  famine, war crimes, rape, incest, homelessness,
  substance abuse.

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Strengths of the scientific approach

• Objectivity to avoid errors of subjective
  judgment labeling and stereotyping
• Statistical data facts, figures and statistics
  are necessary to explain specific problems, eg.
  The morbidity rate amongst the Aboriginal
  population. This can lead to new health
  initiatives.

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Strengths of the scientific approach

• Experimental methods research is crucial to the
  discovery of causes and treatments of various
  diseases which plague mankind.
• Universality it provides a common language and
  knowledge base world-wide, because it is free
  from cultural, social or local differences.

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Nursing critique of science

• Many elements of nursing do not fit the
  scientific approach
• Science may not acknowledge human feelings.
  Humans are not passive receivers of knowledge,
  they like to become involved

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Nursing critique of science

• Science assumes that a person is the sum of all
  body parts science cannot explain some
  phenomena
• Caring cannot be measured
• The supposition that all humans react in similar
  ways leads to funding models based on DRGs and
  Casemix

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Humanistic nursing approach

• The assumptions and beliefs of this approach are
• It is impossible to be totally objective in any
  situation.
• Nursing knowledge includes value and attitudes
  gained through experience as essential to practice

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Humanistic nursing approach

• 2. Not all human phenomena can be explained by
  statistics
• 3. Humanity is subjective we think, feel, hurt,
  grieve none of which can be measured

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Humanistic nursing approach

• 4. Acknowledging patients needs rather than
  things to be done, eg 10 showers to be done or
  10 patients to care for?
• 5. Holistic approach mind, body, social,
  cultural, moral and political

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Biomedical model

• The biomedical model is a term used to describe
  the scientific theory underpinning disease and
  its possible causes in the world
• Many different sciences borrow from its
  philosophy chemistry, biophysics, psychology and
  medicine

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Features of the biomedical model - Focus

• Disease is due to an agent bacteria, chemicals
  etc.
• Treatment is to find the cause and effect a cure
  (there is a relation between cause and effect)

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Features of the biomedical model - Focus

• It must be essentially impersonal
• Cure requires treatment by a professional
  (doctor)
• If one researches for the cause long enough it
  will eventually be found

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Features of the biomedical model - Methods

• Diagnostic tools X-ray, ultrasound, invasive
  procedures
• Treats the episode when it occurs
• Targets specific diseases usually those with a
  high potential cure rate eg. Cardiac bypass
  surgery

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Features of the biomedical model - Methods

• Stresses disease prevention
• but contributory societal factors to illness
  are not necessarily considered unemployment,
  poverty etc

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Features of the biomedical model - Organisation

• The doctor / patient relationship is the chief
  sanctioned interaction
• Emphasis is placed on high technology
  interventions
• Professional dominance is promoted and encouraged

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Features of the biomedical model Health
workers role

• Apply technical expertise
• Act on advice / orders given by the doctors

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Features of the biomedical model Consumers role

• Compliance and passivity

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Features of the biomedical model Resource
Allocation

• Illness care receives most of the health care
  dollar
• Emphasis is placed on institutional care a
  setting in which the biomedical model has
  authority

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Biomedical model Vs health care

• Biomedical model Vs Holistic /
• 
  humanistic approach
• _____________________________________
• Science Vs
  Care Art
• Disease oriented Vs Health
  oriented
• Cure Vs
  Comfort
• High technology Vs Care and comfort

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Biomedical model Vs health care

• Success Vs Palliative care
• Chronic
  care
• Normal
  aging
• health
  promotion
• Specialist Vs Generalist

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Problems with the biomedical model

• Name a few!

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Nursing response to science and the biomedical
model

• What is holism?
• Holos (Greek) whole
• Individuals are more than the sum of their parts.
  If one of the parts is disturbed, the whole
  person is affected.
• The person is viewed as a complete and total being

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Holistic approach to health

• Elements in holistic approach
• Individuals are subject to their class, gender,
  culture and environment and these are taken into
  account

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Holistic approach to health

• All have equal right to appropriate and
  accessible health care
• Holism acknowledges that more than illness can
  affect ones health

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Holistic approach to health

• Implications for nursing practice
• Holism recognises
• That the patient is an individual with personal
  needs, problems and strengths

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Holistic approach to health

• patient interaction and communication are
  essential for successful care outcomes
• Patient is integral to the assessment process. No
  one knows you better than you do.

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Holistic approach to health

• Family / significant others are crucial to
  patients welfare
• Nurse patient collaboration and negotiation are
  integral to health

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Implications for the patient

• The patient believes that an individual care
  approach has been utilised
• The patient realises the best possible outcome of
  care
• The patient achieves their own individual best
  possible potential