Title:
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#Where is the heart of nursing?' : the discourse of validation in nursing.
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The impetus for this study derived from a policy document of the English
National Board (ENB 1985a) which raised the notion of 'peer review of courses', and
from personal experience of some of the first Project 2000 validation events. The
development of a national peer review process would be a radical departure from the
existing closed mechanism of course approval by the statutory body. At the validation
events for Project 2000, nursing as a subject, seemed to be avoided. For me this raised
questions as to what these validation events were achieving.
The study begins by introducing the theoretical framework which was central to
understanding how knowledge for nurses has been developed and approved. This
incorporates notions of power (Lukes (1974), the sociology of knowledge, and
communication (Habermas 1970). Strategic power has been exercised over nurses
through patriarchal strategies to control nurses work and access to knowledge, and
legitimately by nursing's statutory body to approve pre-registration courses. The advent
of Project 2000 courses required conjoint validation with higher education. The change
in the approval process has enabled shifts in power relations to occur. Since knowledge
claims are part of what is validated through academic debate, the question raised was
"how do nurses account for nursing know ledge and how is this recognised at validation
events?"
The nature of the data to be collected and analysed was informed by the
theoretical framework and the research methodology, discourse analysis (Potter &
Wetherell 1987). Data included; literature that provided historical and contemporary
information about the development of 'knowledge for nurses', 'nursing knowledge' and
validation; official circulars from the statutory body related to curriculum development
for Project 2000; course documentation presented at four validation events; the official
reports from those events; field notes of the validation events. Discourse analysis is
concerned with language use and aims to explore the subtleties and complexities of
technical explanations in natural contexts. It focuses both on the variation and
construction of accounts and involves developing hypotheses about the purposes and
consequences of language.
The first stage of the analysis revealed that validation discourse was constructed
through the use of four interpretive repertoires. The' assimilatory' and' accommodatory'
repertoires were used to demonstrate how ways of working either did or did not follow
agreed procedures/rules. The 'accounting through theories' and 'accounting for (nursing)
educational processes' repertoires were used to account and not account for nursing. The
second stage explored the function of the repertoires. One pair of competing repertoires
were used to either exercise power or create conflict. Conflict was also created when the
repertoires came together. A voiding this was worked hard at by validators and validatees
and was achieved through an 'appeal to a higher authority' device. The second pair of
repertoires ensured that whilst certain aspects of nursing were discussed, practice
knowledge was avoided. The repertoires were also used to prevent certain issues getting
on the validation agenda, significantly practice knowledge.
The validation events were arenas in which the use of strategic power and
communication dominated. Their use illuminated issues which constrained validators and
validatees, and which militated against the notion that validation was conducted by peers
in an 'ideal speech situation'. There is discussion of ways in which discourse analysis
and critical theory can be brought together to capture practice knowledge and emancipate
the discipline of nursing
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