Oral Presentation The 26th International Nursing Philosophy Conference 2023

Step by Step Around in a Circle: Structured Reviews of the Literature as a Social Defense Against Anxiety (#40)

Stephen Padgett 1
  1. California State University Fullerton, Fullerton, CA, United States

A number of highly structured practices of reading and writing have become prominent in the health sciences literature, such as systematic reviews, integrative reviews, and meta-analyses. Along with hierarchies of evidence, evidence tables, explicit search strategies, and PICO questions, students are taught to rely on procedural rules for research evaluation and interpretation.  These practices are broadly associated with “evidence-based practice”, an idea which has been both championed and attacked within nursing. The critiques have typically focused on epistemological and professional-identity questions, such as “what kinds of knowledge do nurses have or need?”  

What I want to do instead is to approach these tools from a sociological perspective, to ask not “Do these tools work?” but rather, “What work are they doing?” For nursing academics in particular, why do we find rule-based systems so appealing? To explore these questions, I will draw on the work of Isabel Menzies (1960), whose analysis of a nursing service in a London hospital explored the idea of social systems as a defense against anxiety. Among Menzies’ many observations of hospital nursing which might be applied to academia are the ritualization of practices, the deferral upward of authority, the inability to reconcile the needs of care and education, and the resistance to change despite clear dysfunction.  The anxieties in this case are not the psychodynamic topics of death, desire, the helplessness of infancy, etc., but rather the highly fraught relationship between nursing practice and education, the ambivalence about “belonging” in the university, and the uncertainties of exercising judgement.  Could it help us to consider academic rituals as a social defense against anxiety? Are there perhaps other ways to manage those tensions?