Standpoint Epistemology and Nursing Knowledge Chapter 6 BEF 644 Philosophy of Science in Relation to

Nursing Education Research Dr. Stephen Tomlinson October 24, 2014 Quiz # 2 Amelia E. de los Reyes

Nursing Knowledge: Science Practice and Philosophy

Episteme – knowledge/science

Epistemology – knowledge production, the part of philosophy that deals with questions involving the nature of knowledge, the justification of beliefs, and rationality.

Standpoint Epistemology – is a framework for producing knowledge from the point of view of the person doing the research.

Definition of Terms

Dorothy Smith – founded the feminist standpoint theory which looked at the social world from the perspective of women in their everyday world and the ways in which women socially construct their world.

Feminist Standpoint is essential to examining the systemic oppressions in a society that standpoint feminists claims devalues the women’s knowledge.

Standpoint feminism makes the case that because women’s lives and roles in almost all societies are significantly different from men.

What Can Standpoint Epistemology Tell Us About the Relation Between Nursing Values and Nursing Knowledge?

Standpoint feminism makes the case that women hold a different knowledge than man.

That women role as subordinated group allows women to see and understand the world in ways that are different and challenging to the existing male-biased conventional wisdom.

What Can Standpoint Epistemology Tell Us About the Relation Between Nursing Values and Nursing Knowledge?

Nurses have a role in healthcare and are charged with certain responsibility because they provide a socially valuable service. The scope of nursing practice is partly social and political.

Nurses are entrusted with responsibility in a particular domain because they have relevant, specialized knowledge.

Nursing Theorist, Researcher and Their Colleagues Wrote the Importance of Nursing Values and Nursing Knowledge in the Profession of Nursing:

Standpoint theorist believes that some of our social role can produce more accurate knowledge of a particular group than others.

Social Theorist have strong believes that social relationship are ultimately determined by what we do in society.

Social Role and Epistemic Privilege

Marx called the human activities as the foundation of society “material practices”.

Marx ideology of capitalism where the ruling class dominates the working class and keeps them in power.

Marx believes that social relationship are constituted by material practices and by what people do and by doing so, participants do not have any clue or understanding of their own society.

Marxist Standpoint Epistemology

Marx believes that the distorted view of social relationship is what keeps the ruling class in power. He explained that owner of the ruling class thinks that his labor arrangement with his worker are fair and just.

Marx further explained that the reality is quite different because the laborer are forced to accept what the owner offers them to feed their family or meet their needs.

Marxist Standpoint Epistemology

Marx explained that because of this relationship the working class is more in position to understand social relationship from both the ruling class perspective and from his own perspective of the laborer that makes the system works.

Marx states that the ideology of the ruling class distorts the working class viewpoint as well as their own.

The standpoint of the working class requires struggle, especially political struggles.

Marxist Standpoint Epistemolgy

Feminist theorist and social scientists saw the obvious parallel between gender and class relationships which shows that men holds power in society and they control the material practices that constitute social relation.

Feminist objections to Marxism; masculine dominance is not strictly economic and feminist objections to Marxism is that women’s work in the home was invincible to standard model of economic exchange.

Feminist Appropriation of Standpoint Epistemology

Feminist theories claims that women’s role are in position to better understand the male’s perspective and understand what make that perspective possible. Women has adequate understanding of society and how society is structured by gender.

Feminist Scholar made claimed that the working class was in a privilege epistemic position with respect to social relationship,

Feminist Appropriation of Standpoint Epistemology

• Early version of standpoint epistemology were challenged in their position of wanting to argue male-biased science. Critics think that feminist science was more than the demand that science supports feminist values.

• Early version of standpoint epistemology was that they “essentialized” gender, race and class. Standpoint epistemology argues that only from oppressed positions can one explain why the dominant group has a distorted understanding of social relationships.

Feminist Appropriation of Standpoint Epistemology

Standpoint epistemology think that strong commitments of class consciousness or object-relations theory were unnecessary. Commitment to different social roles for men and women is sufficient to generates the epistemological difference required by standpoint epistemology.

(Harding, (1991) note that this commitment permitted standpoint epistemology to embrace diversity of women’s role, experiences, and ways of being.

Generalizing Standpoints

Epistemically privileged standpoint exists when a pair of social roles satisfies the following conditions:

1. One role is oppressed relative to another, dominant role.

2. The relationship between the roles is structured by the needs and interests of the dominant role.

Generalizing Standpoints

3. The practices of the subordinate role make the activities of the dominant role possible, and those activities are largely invisible to the dominant group.

4. In order to fulfill their role, those who occupy the subordinate role need to understand some domain from both the perspective of the dominant role and from their own perspective.

Generalizing Standpoints

Contemporary health care is a collage of roles that divide labor as well as knowledge. Can the standpoint analysis be extended to the relationship between doctors and nurses?

Florence Nightingale secularized and professionalized the role of the nurse. She established the domain of nursing expertise. This domain was necessary part of patient care, and it was different from the physician’s domain of diagnosis and treatment.

Generalizing Standpoints

Nightingale built the power of inequality between men and women into the relation between doctors and nurses. If standpoint epistemology is right, then such inequality of power can indeed produce powerful asymmetries of knowledge. Does the position of a nurse within the health care hierarchy provide a kind of epistemic privilege?

Generalizing Standpoints

Maureen Coombs found in her study that nurses meets the four conditions of epistemically privileged standpoint. Her study was on ethnography of three British intensive care units.

Coombs main focus was the way that knowledge and roles are used within the decision-making process in the delivery of health care.

Coombs conducted interviews and observed ward rounds. Rounds are crucial sites for understanding how power and knowledge interact.

Knowledge and the Division of Labor in Health Care

Coombs found that both physicians and nurses used the biomedical model of health and the associated knowledge of physiological systems in their responses to the patient.

Coombs found the both physicians and nurses were fluent and comfortable with the languages of sciences like chemistry, pharmacology, etc.

Knowledge and the Division of Labor in Health Care

Coombs found out that physicians and nurses recognized the distinct expertise of nurses from a physicians expertise. Physician still delegates responsibilities to nurses that are basic bedside nursing care like bath, skin care, mouth care, bowel care, etc.

Coombs found that nurses were primarily the liaison between the family and the medical world of the hospital. Nurses understood the technical aspects of care, they could explain procedures and help the family anticipates outcomes.

Knowledge and the Division of Labor in Health Care

Coombs found that nursing expertise arose from nurse’s continuous presence with the patient. Nurses has detailed knowledge how the patient were responding to treatment, to sedation, and to analgesia. Nurses know if patients had a rough day or night, know how to use equipment, manipulate them and is responsible making sure they are working properly.

Coombs found in her study that all the expertise the nurses have were not recognized as a kind of knowledge.

Knowledge of the Division of Labor in Health Care

Coombs study found both power and knowledge differentials between doctors and nurses. Physician’s knowledge was treated as the more important form, and the areas of nursing expertise were marginalized.

Coombs found it interesting that in spite of the frustration nurses felt, both physicians and nurses treated the nursing expertise as secondary to the physician’s knowledge.

Knowledge of the Division of Labor in Health Care

Nurses roles meet the four criteria for an epistemically privileged standpoint but the role of the nurse in health care is oppressed and marginalized compared with physician’s role.

Physicians dominated the practice of medicine. Nurses has worked hard to get recognition for their contributions they made in nursing. The system still consider the role of nurses is largely determined by the needs of the physicians.

Nursing Knowledge and Nursing Roles

Coombs study found physicians and nurses regarded physicians as the primary decision-makers and dominated the rounds. The nurses’ expertise was treated as a superficial addition.

Coombs found that the relationship between physicians and nurses is largely structured by the need of the physicians.

Nursing Knowledge and Nursing Roles

Coombs study showed that physicians know what nurses do but they do not appreciate the ways in which nursing work makes their treatment possible. Coombs found that nurses were fluent in the language of biomedicine and mobilized the same knowledge as physicians.

Standpoint epistemology relies on the idea that moral or political values can be constitutive to scientific inquiry. The knowledge that nurses have of human health in the special role they play in health care can be uncovered.

Nursing Knowledge and Nursing Roles