Carry on thinking: Nurse education in the Corporate University.

It is widely acknowledged that the modern university can be traced back to the inauguration of the University of Berlin in 1810. In the subsequent two centuries, the idea of the university has taken on many forms, largely driven by the political concerns of the day and often in response to demands from the electorate for greater state regulation and accountability for public spending. Until recently, the responsibility for academic and social legitimation had shifted between the church, the state and the university itself. However, in opening up the higher education sector to the influence of the market economy, the state has surrendered much of its political influence over the academic governance of the university to the power of the consumer, which is to say, to students. In this essay, I trace the history of the modern university and examine the significance and implications for nurse education of the turn towards the market. Drawing on the work of Derrida, Lyotard and Readings, I suggest that the return to liberal education is no longer possible, and argue instead for a philosophical strategy of subversion.

A sacred command of reason? Deceit, deception, and dishonesty in nurse education.

Kant (Grounding for the Metaphysics of Morals. Hackett, Indianapolis, 1797) described honesty as 'a sacred command of reason' which should be obeyed at all times and at any cost. This study inquires into the practice of dishonesty, deception, and deceit by universities in the UK in the pursuit of quality indicators such as league table positions, Research Excellence Framework (REF) scores, and student satisfaction survey results. Deception occurs when the metrics which inform these tables and surveys are manipulated to suggest an improvement in quality when, in fact, the raised scores are merely the result of clever strategic planning. Deceit occurs when these manipulated scores are deliberately and knowingly presented as real improvements in research and educational quality. It might be argued that, within the context of the artificial ivory tower world of academe, this is a game played by almost every academic in every higher education institution with no real losers and little wider consequence. However, this study suggests that some of the strategies employed by institutions to improve their scores without directly addressing the issue of quality can, in certain practice-based disciplines such as nursing, result in dire consequences for practitioners and service users. It concludes with a number of suggestions taken from personal experience to resolve the tension between the contractual demands placed on nurse academics by their employers and the moral and practical obligations of their professional body, most notably the use of subversion. The conclusion, contra Kant, is that the most effective strategy against dishonesty and deception is often more dishonesty and deception.

Foundations for a human science of nursing: Gadamer, Laing, and the hermeneutics of caring.

The professions of nursing and nurse education are currently experiencing a crisis of confidence, particularly in the UK, where the Francis Report and other recent reviews have highlighted a number of cases of nurses who no longer appear willing or able to 'care'. The popular press, along with some elements of the nursing profession, has placed the blame for these failures firmly on the academy and particularly on the relatively recent move to all-graduate status in England for pre-registration student nurses. This has come to be known in the UK as the 'too-posh-to-wash' argument, that there is an incommensurability between being educated to degree level and performing basic nursing tasks. I will argue in this paper that the diagnosis of the problem is substantively correct, but the formulation and the prescription are misguided and dangerous. I will suggest that the growing emphasis on research-based and evidence-based practice is the logical conclusion of an inappropriate scientific paradigm for nursing which is underpinned by the social sciences, by technical rationality, and by a focus on people. In contrast, I will suggest that a more fruitful way of thinking about and practising nursing and nurse education is to consider it as a human science with a focus on persons in which evidence for practice derives largely from practice itself. The history of the idea of a human science is traced from its roots in nineteenth century hermeneutics to the work of Gadamer and R.D. Laing in the 1960s, and I attempt to imagine a paradigm for nursing practice, scholarship, and education based on Laing's 'existential-phenomenological' approach with a focus on the endeavour to understand and relate to individual persons rather than to make broad prescriptions for practice based on statistical and other generalizations.

Understanding advanced nursing practice.

Articles published in Nursing Times in 2012 presented the role of the advanced nurse practitioner as an extension into the territory of junior doctors in response to pressures in healthcare resources. This article traces the history of advanced practice and suggests that a more appropriate model, post Francis report, should focus on fundamental skills and core nursing values. Rather than attempting to plug a gap created by a shortage of doctors by developing medical skills, nurses should value and promote advanced nursing practice, which is driven by patients' needs for the care that doctors are unable and unskilled to provide.

A new vision for advanced nursing practice.

Part one of this series suggests that the post-Francis era requires a perspective on advanced nursing practice that emphasises, celebrates and rewards the development of core nursing skills, values and attitudes rather than extending the role of the nurse into medical territory. This article offers some thoughts and ideas that attempt to move the focus away from the notion of advanced practice as the development of a particular role towards the idea of advancing practice as a team of like-minded professionals working together in practice innovation units for the benefit and wellbeing of patients.

Rethinking reflective education: What would Dewey have done?

Reflective practice has largely failed to live up to its promise of offering a radical critique of technical rationality and of ushering in a new philosophy of nursing practice and education. I argue in this paper that the failure lies not with the idea of reflective practice itself, but with the way in which it has been misunderstood, misinterpreted and misapplied by managers, theorists, educators and practitioners over the past two decades. I suggest that if reflective practice is to offer a credible alternative to the current technical-rational evidence-based approach to nursing, then it needs to rediscover its radical origins in the work of John Dewey and Donald Schön. In particular, nurses need to look beyond their current fixation with reflection-on-action and engage fully with Schön's notion of the reflective practitioner who reflects in action through on-the-spot experimentation and hypothesis testing. Finally, the implications of this radical approach to reflective practice are developed in relation to the practice of nursing, education and scholarship, where they are applied to the challenge of resolving what Rittel and Webber refer to as 'wicked problems'.