The 'core of nursing': knowledge and skill.

摘要

In 2005 when our book Complexities of care: Nursing reconsidered (Nelson and Gordon; published by Cornell University Press) was released we had some flutters of anxiety. Our book set its sights on a score of sacred cows. We questioned the conventional understanding of the mind-body split in nursing, arguing that nursing's interest in holism had paradoxically left out the body side (Gordon). We were critical of the wholesale acceptance of the novice to expert delineation of expertise (Nelson), arguing that the idealistic view of the expert (including expertise in the ethical domain) reduced the achievements and competencies of most (imperfect) nurses to inexpert. Tom Keighley argued that nursing's focus on prevention and health promotion has in effect led to a professional lack of interest in care of the acutely ill, and thus effectively abandoned nursing's core constituency, leaving the care of the sick to cheaper and less educated workers. Two chapters (Aranda and Brown; Heartfield) provided compelling data showing the role nurses played in the management of patient expectations during the implementation of new systems of care that were focused on cost-cutting and reducing services. Finally in a chapter we co-authored, we critiqued the dominant discourse of caring, which permeates every aspect of nursing, from undergraduate curricula to licensure, service accreditation, professional associations and research organizations.