The contested status of theory/theorizing and humanism/posthumanism in Olga Petrovskaya's Nursing theory, postmodernism, poststructualism, and Foucault.

Abstract

Every academic discipline it seems has its own version of what in professional philosophy has long been called the “analytic/continental split.” It is a story, at least in part, about the professionalization of the disciplines in the academy in the 19th and 20th centuries, although its roots go deeper. Once nursing education moved out of the clinical setting and entered the academy in the latter half of the 20th century (at least in the United States, Canada, United Kingdom, and Australia), it too developed a version of this story, a set of narratives outlining its own image of thought, an account of its own epistemological grounding and metaphysical orientations. Olga Petrovskaya's new book—Nursing theory, postmodernism, poststructualism, and Foucault—tells something of this story in relation to nursing, about what the author calls the “nursingness” of nursing (2023, p. 12), at least of American nursing and how it played out between 1990 and 2010. The thesis or central argument of the book is that nursing knowledge, that is, the science and theory thought to be unique to American nursing, is produced via a “power-knowledge” regime, what Petrovskaya refers to as “the matrix of (un)intelligibility” (2023, p. 12). Some of the signature concepts of the French philosopher Michel Foucault figure prominently and, for those unfamiliar with Foucault's work, the basic idea is that knowledges and their translation into practices, behaviors, beliefs, and actions are conditioned by structures of power, an “episteme” that controls what can said and thought. Petrovskaya uses this Foucauldian idea to claim that in the matrix of American nursing only a certain kind of knowledge is intelligible and makes sense. Knowledge that is unique to American nursing science and theory is, according to Petrovskaya, ultimately grounded in and derived from “a logical positivist conception of science” (2023, p. 8). One effect of this is to make “certain continental theoretical practices” (2023, p. 8, italics in original), that is, certain postmodern and poststructural approaches, either unintelligible, invisible or simply unrecognizable. To make this argument, Petrovskaya's book focuses on a “textual analysis” (2023, p. 8) of nursing scholarship covering roughly two decades from 1990 to 2010, the period in which citations of poststructuralist thinkers, and “French theory” generally, peaked in articles published in a curated selection of “theoretical” nursing journals and textbooks. Petrovskaya outlines her experience in graduate nursing education and the distinction between American nursing knowledge, as taught in both her undergraduate and graduate curricula, and which contrasted with the kinds of theorizing characteristic of continental philosophy that turned up at specific nursing conferences and journals in the period between 1990 and 2010. She then offers a survey of how continental philosophy was imported into nursing in the 1980s and 1990s, and the various ways nurse scholars took up these ideas. Petrovskaya suggests that some types of continental thought (e.g., Habermas) were more easily accepted into the American nursing intellectual matrix because they were perceived as less critical of conventional American humanistic and normative traditions in nursing. Others (e.g., Foucault et al.) were perceived as “uncomfortable bedfellows” (2023, p. 27) for nursing because they threatened to challenge those same humanistic and normative assumptions. In many ways, the third chapter is crucial for the book as a whole because it outlines how the matrix of American nursing theory was formed in the crucible of logical positivism. Here, Petrovskaya leans very heavily upon the claims and arguments in Mark Risjord's (2011) Nursing knowledge: Science, practice, and philosophy. The basic idea is this: the fledgling nursing profession with its newly minted academic status was looking around for a model that would secure its autonomy and identity in the American Academy. Nursing needed its own science, an abstract knowledge and set of theoretical principles that would distinguish it from other disciplines, especially medicine. Nursing made a decision to take up then-current scientific norms of logical positivism as its own goal—that of developing discipline-specific theories including axioms, general laws, and the positing (and testing) of hypotheses in a deductive nomological or pyramid like pattern. Following Risjord, Petrovskaya argues that the influence of positivism, although only rarely acknowledged explicitly, permeates nursing from the 1970s on, including the continued assumption that academic nursing constitutes a science as such. Petrovskaya then argues that continental theoretical practices are well suited toward ferreting out the residual and subterranean influence of positivism, despite the stated denials and conscious rejections by American (self-declared) scientists. It is in this context over the ensuing decades that the reception and development of poststructural and postmodern approaches in nursing took place. Petrovskaya works out how this reception occurred in what she calls “American nursing science.” She identifies two streams. One stream is exemplified through Susan Gortner, a nurse scientist serving in the Federal agencies supporting nursing research in the late 1960s to early 1970s. For Gortner, science constituted empirical research “to solve problems encountered in clinical nursing practice” (2023, p. 77). While Gortner was sympathetic to postmodern thought, her positivist orientation forced a rejection of “the postmodern relativization of scientific truth” (2023, p. 79) and thus a concomitant rejection of its viability as a path for developing nursing knowledge. The other stream, called “American nurse theory,” did take up postmodern thought, but only to the extent it was radically transformed into what was anachronistically termed “postmodern nursing science” (2023, p. 80). Petrovskaya is highly critical of this move “claiming scientific status for the kinds of scholarship that are better understood as humanities-type inquiry and theorizing” (2023, p. 90) Petrovskaya (2023, p. 98) describes an “enclave group” of American scholars using postmodern theory to demonstrate the limitations of American postmodern nursing science and offering instead “alternative theoretical directions for nursing scholarship.” Petrovskaya (2023, p. 112) argues that, while the enclave offered powerful critiques of the assumptions grounding American nurse theory, they were nevertheless “powerless to disturb the status quo.” Petrovskaya reasons this is related to the unproblematic assumption in positivism of the autonomous human being, which is problematized in the postmodern scholarship of non-American postmodern nurse scholars along with the enclave scholars. Petrovskaya (2023, p. 122) argues that the assumption in American nursing theory of a “humanistic subject as the autonomous self-identical actor” means the actual intellectual content of nursing practice is never examined or theorized. What concerns Petrovskaya (2023, p. 124) is that this assumed humanism, of the nurse and of the person cared for, represents “an unquestionably positive and desirable connotation” that does not allow for recognition of “the nurse-patient encounter as [for example] a contentious site of power” (p. 122). Without this recognition, Petrovskaya argues that the clash between the American ideal of the nurse and what happens in nursing practice is a dangerous state of affairs that American nurse theorists nevertheless continue to render invisible through their assumptions about what a nurse is doing with their patients—“a power-free encounter controlled solely by the nurse's [autonomous and] benevolent intent” (2023, p. 125). In contrast, Petrovskaya argues that non-American and enclave scholarship, which orients posthumanistically, does do the work of providing rich descriptions and important critiques of nursing practice that don't rely on positivist notions regarding what it means to be human. Petrovskaya concludes that humanistic methodologies constructed through a postmodern orientation (e.g., actor network theory and practice theories) afford “better tools” for analyses of nursing practice than what American nurse theory/science has developed and championed. Petrovskaya rehearses her main argument in the final chapter, that American nurse theory/science has, because of its continued positivist and humanist orientation, for the most part comprised “a jumble of misreadings and criticisms of postmodern and poststructural theory” (2023, p. 140). The result of this has been the continued marginalization of continental and posthumanist theorizing in/for nursing; that for the most part “the American [positivist] intellectual matrix … [still] dominates the discipline's theoretical imagination” (2023, p. 147). Arguably, American nurse theory/science has indeed been superseded in the years since 2010, when Petrovskaya's analysis ends. But it is not continental/postmodern theory that has taken its place. Instead, it is EBP that has become the dominant paradigm within nursing and other health disciplines over the last two decades (Satterfield et al., 2009). This is not the place to rehearse the EBP debate in nursing, which had a passionate efflorescence in the nursing literature in the 2000s and 2010s critiquing the unproblematic uptake of EBP as the model prescribing how nursing and healthcare should be studied and organized (Holmes et al., 2006 and Thorne & Sawatzky, 2014 come immediately to mind). But it's worth noting that the nursing science exemplified by Susan Gortner in Petrovskaya's book, focused on “clinical, behavioral, outcome, and evaluation research” (2023, p. 56), conforms precisely to EBP principles and (perhaps therefore?) is what currently grounds the majority of American nursing scholarship, education, and practice. This key insight helps to explain the American nursing theory/science continued reliance on positivist conceptions, but it is not addressed in Petrovskaya's book. Yes, nursing sought out its own unique knowledge base and found concepts in positivistic science that were congenial for that purpose. But why nursing continued, and continues today, to be informed by such concepts when both professional philosophy and many social sciences have long since dropped them is not tackled in the book. In addition, why poststructuralist ideas gained more traction in nursing theory in the United Kingdom, Australia, and other countries (but not the United States) during the period under study—despite the fact that positivism is arguably just as influential in those countries—isn't addressed. One comes away with the sense that Petrovskaya gives us a partial subset of conditions that contributed to the development of American nursing theory/science, but that there is a much bigger story to tell. That bigger story would surely need to include the role of neoliberalism as a form of governmental reason. It is arguably under this framework that contemporary nursing science and knowledge are understood and in which the use of evidence and competency-based nursing education makes sense. Indeed, it is perhaps the distinctive feature of American nursing that it takes place against a background where healthcare has already been outsourced as a private good for individual investment and consumption. What neoliberalism brings to the conversation is the idea that not only the patient, the doctor and the nurse, but every field of action that health care touches upon, is treated as an economic actor and construed in terms of speculative market metrics: competencies, ratings and rankings. Petrovskaya's book can be seen as a contribution to this bigger story of the “government of nursing” in the 20th and 21st centuries. Bringing the threads together, we can say that the matrix of intelligibility of American nursing, shaped by the metaphysics of humanism, is situated within a broader government of nursing whose political and economic stakes are played out in neoliberalism. Although Petrovskaya discusses “antihumanism” as a critical foil, it is perhaps toward posthumanism that the book gestures. In what has been called the “posthuman convergence” (Braidotti, 2019) critiques of humanism need to be brought into conjunction with critiques of anthropocentrism without simply merging them together. By challenging the humanistic assumptions and neoliberal conditions that enable the matrix of intelligibility to function, the posthuman offers the potential to not just focus on the “events and materialities of nursing practice” (Petrovskaya, 2023, p. 132), but push nursing toward new directions and new futures. The scholarship resulting in this article was conducted with support from the Center for Nursing Philosophy at the University of California, Irvine. The authors declare no conflict of interest. No data were used.