Nursing Knowledge and the Placebo Effect

Abstract

Nursing knowledge stems from a dynamic interplay between population-based scientific knowledge (the general) and specific clinical cases (the particular). I compare the “cascade model of knowledge translation” (or “classical biomedical model”) in clinical practice with an emergentist model of knowledge translation. First, the structure and dynamics of nursing knowledge are outlined, whereby the distinction between epistemic and non-epistemic values is clearly set. Then, an emergentist approach to nursing knowledge is proposed, based on the assumption of a two-way flow from the general to the particular and vice versa. The case of the “placebo effect” is analysed as an example of emergentist knowledge. It has been difficult to explain the placebo effect within the classical biomedical model; I underscore its importance in shaping nursing knowledge. In fact, nurses are primarily responsible for administering placebo in the clinical setting and have an essential role in promoting the placebo effect and reducing the nocebo effect. The beliefs responsible for the placebo effect are: (i) interactive, because they depend on the relationship between patients and health care professionals; (ii) situated, because they occur in a given clinical context related to certain rituals; and (iii) grounded on higher-order beliefs concerning what an individual thinks about the beliefs of others. It is essential to know the clinical context and to understand other people’s beliefs in order to make sense of the placebo effect. This type of therapeutic outcome only works when the (higher-order) beliefs of doctors, nurses and patients interact in a given setting. Finally, I argue for a close relationship between placebo effect and nursing knowledge.