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Nurses' understanding of physical science in nursing practice.

When science educators teach nurses, their primary aim should be to help them to develop understanding of their world of nursing. From a study of registered nurses' conceptions of the physical science underlying their clinical practice, we assert that nurses' understanding of the physical sciences is inadequate in terms of the competencies required of them as nurses. Rather than respond to this contention by altering the content of physical science units in nursing courses, we propose that those who teach nurse students should look more carefully at factors that influence nurses' learning: these factors are images of nursing, shared experience and shared language. We maintain that these factors should not be ignored but can be used to advantage in teaching science to nurses.

Curriculum

Reductionism in physical sciences.

The idea of reductionism in physical sciences is that all physicochemical observables can be described in terms of a limited number of particles and their variable energies. Here we limit ourselves to atomic descriptions showing how very successful reductionism is in treating equilibrium systems. This includes all properties of single molecules, even DNA, and can be extended to dynamic assemblies of molecules through the variables composition, potential energies, kinetic energies (temperature) and volume (pressure). This description includes the capacity of a system to change, to do work. It does not include working or changing systems when we have to consider time-dependent variables such as directed motion, flow. Analysis of such accidentally or purposefully directed activity seems, to the author, to be outside the above reductionist analysis in that its feature is organization around a 'plan' or a 'cycle'. Thus reductionism fails to describe machines, man-made or biological, in that the parts are arranged, even dedicated, to a total function.

Energy Transfer

[A humane picture of the human? Prolegomenon of change in the human image in anatomy].

When during the last three decades of the 19th century German clinical medicine was established as a natural science anatomy e.g. was referred to as a model on this way. At that time this discipline, however, was delved into Richtungskämpfe between evolutionary morphology on the one side and physiological and clinically orientated anatomy on the other, comprising a discussion on the Wissenschaftlichkeit of the different directions. In the end anatomy evolved as a medical discipline leaving evolutionary morphology to the zoologists. Concomitantly with this change in the self-conception of the discipline as a natural science anatomy was charged with the imprinting of the prospective physician and his picture of the human being. This respective picture is analysed in the anatomical illustration from Vesalius up to nowadays considering the unity of art and anatomy in the visual media as well as in its disjunction. In this context the dominance of science on art in the service of anatomy is discussed with special reference to the neoclassical influence on further development. The latter is characterized by an increasing abstraction and diagrammatic representation of the human figure referring to man as a reparable electrochemical machine without mystery. This corresponds to a clinical medicine comprehending as a reparative and mechanical profession. The restoration of a humane picture of the human being may be achieved by an anatomy directed to life and an art extended to an anthropological conception.

Anatomy, Artistic

[A human representation of humans? Changes in human representation in anatomy].

When during the last three decades of the 19th century German clinical medicine was established as a natural science anatomy e.g. was referred to as a model on this way. At that time this discipline, however, was delved into Richtungskämpfe between evolutionary morphology on the one side and physiological and clinical orientated anatomy on the other, comprising a discussion on the Wissenschaftlichkeit of the different directions. In the end anatomy evolved as a medical discipline leaving evolutionary morphology to the zoologists. Concomitantly with this change in the self-conception of the discipline as a natural science anatomy was charged with the imprinting of the prospective physician and his picture of the human being. This respective picture is analysed in the anatomical illustration from Vesalius up to nowadays considering the unity of art and anatomy in the visual media as well as in its disjunction. In this context the dominance of science on art in the service of anatomy is discussed with special reference to the neoclassical influence on further development. The latter is characterized by an increasing abstraction and diagrammatic representation of the human figure referring to man as a reparable electrochemical machine without mystery. This corresponds to a clinical medicine comprehending as a reparative and mechanical profession. The restoration of a human picture of the human being may be achieved by an anatomy directed to life and an art extended to an anthropological conception.

Anatomy

What is a clinical fact?

As a preliminary to the question, 'What is a clinical fact?', the author asks the wider question, 'What is a fact?', answering that facts are double in aspect: they both say how the world is, and they also depend on our species, our language, theory, etc. A claim of fact in any empirical discipline--in the natural sciences or in human studies with their different methods--is a truth claim which is not infallible or unique to the fact, and also a claim that must offer itself for verification. Using the clinical record of three sessions, she then tries to answer the question, 'What is a clinical fact?', offering the starting formulation that clinical facts, under the unusual conditions of an analytic hour which give an analyst access to a patient's inner world, manifests themselves in the form of immediate psychological realities between patient and analyst. On the way, the author discusses the analyst's anxieties about making a claim of clinical fact; further striking features emerge about clinical facts in the three sessions, and some unsolved problems, i.e. the variety of analytic theories, subjectivity and objectivity, are noted. Even while they bear the perplexities of their problems, clinical facts are of great significance to the study of the mind. They extend the domain of psychology to the area of the mind's interiority, with its human experiences of subjective meaning, conscious, and especially unconscious.

Adolescent

[Laboratory medicine in the area of interest between medicine and science].

The scientific disciplines of laboratory medicine are analyzed from the point of view of history and the philosophy of science. The results of this study are the following: 1. Laboratory medicine is the name of a group of subjects which exist in an interdisciplinary area between medicine and science. 2. Historical development shows that these subjects arose in the 19th century when medicine adopted the "natural scientific method" and became "scientific medicine". 3. Clinical chemistry, as one example of these subjects, is analyzed in detail to understand the thinking process and the scientific method. This subject is, on the one hand, a "theoretical discipline" (like all of the natural sciences) but, on the other hand, it is a typical "practical scientific discipline" (which like clinical medicine is aimed at certain decisions and actions). 4. The disciplines of laboratory medicine have developed typical "professions" mainly because of their application in clinical practice and their commitment to patient care.

Chemistry, Analytic

A paradigm for the next millennium: health information science.

Although historically a major concern of both the artist and the scientist was the observation of nature, the two disciplines split when science became more wedded to mathematics and quantification. Today, with visualization, art and science can again together provide a view of the natural world. A prototype curriculum for a new multidisciplinary science--Health Information Science--incorporates aspects of computer science, cognitive psychology, bioengineering, biomedical visualization, medicine, dentistry, anthropology, mathematics, library science, and the visual arts.

Art

The future of psychoanalysis.

We have tried, in a necessarily kaleidoscopic and highly condensed manner, to highlight our perspectives on the foreseeable future of psychoanalysis, along a number of interrelated but clearly distinct dimensions. Our discussion has dealt with the nature of our field as a science and also as a discipline, the nature of the training for it, the nature of its research, and the nature and scope of its professional practice. In all of these areas, matters seem both more complex and less clear-cut than they were in the immediate post-World War II period when we entered the field, which is now forty years ago in the approximately one-hundred-year-old history of psychoanalysis. We did not discuss in any detail the International Psychoanalytical Association or the American, its component through which we have our international membership. We have, however, via the IPA Newsletter, given voice to the organizational struggles of the International: the April 1989 issue of the Newsletter carries our account of the organizational changes within the IPA during the last four years and what we think they mean in relation to some of the issues discussed in this article. The fuller story of how our changing psychoanalytic life and identities are reflected in our institutional structures, as well as a more detailed specification of the future directions we have tried to chart in our inquiry, all deserve separate extended treatment and more complete justification.

Forecasting

Medical education in the former Soviet Union.

After World War I, medical education in the Soviet Union and medical education in the United States headed in strikingly divergent directions. In keeping with the recommendations of the Flexner report, medical education in the United States became a university-based academic discipline based in the natural sciences. In contrast, the Soviet Union created a series of free-standing medical institutes whose admission, curricular, and pedagogic policies were centrally controlled in strict conformity with political doctrine. Notable features of the Soviet system were narrowly defined professional education; early specialization, beginning in the first year of medical school; and emphasis on empirical clinical training at the expense of scientifically based education. Despite the historical differences between Soviet and American medical education, there are several issues that face present-day medical educators in both the United States and the Soviet successor states. These include an overabundance of specialists, the need to provide equitable professional opportunities for physicians of both sexes, and the need to provide access to medical education for qualified candidates from underrepresented social or ethnic groups or from geographically remote regions.

Academic Medical Centers

[Is nursing a science or a profession?].

Traditionally, human knowledge has been considered in the context of disciplines which can be divided in two groups: Academics and professionals. The aim of academic disciplines is the knowledge and their theories are descriptive in nature. For this reason they are named science. In contrast, professional disciplines are move comprehensive, directed toward practical aims and there is a need to and to work. Nursing as a professional discipline has been influenced by four school of thought named; service, administration, academic and practice. Currently the nursing practice is developed based on three different theoretic and philosophic branches.

Brazil

The consciousness disciplines and the behavioral sciences: questions of comparison and assessment.

In recent years a number of assessments of the non-Western consciousness disciplines have been undertaken by Western behavioral scientists. The author suggests that a variety of conceptual, methodological, experimential, and content inadequacies render the conclusions of these investigations of doubtful validity. He then describes the models of human nature postulated by these disciplines and the Western behavioral sciences, suggesting that comparing them results in a paradigm clash. The failure to recognize this clash seems to have resulted in inappropriate pathologizing interpretations. Attention is drawn to the relevance of recent findings in state-dependent learning, meditation studies, peak and transcendental experiences, transpersonal psychology, and quantum physics to an assessment of the consciousness disciplines, and suggestions for more adequate investigation are provided.

Behavioral Sciences

The Japanese Association for Acute Medicine (JAAM).

The Japanese Association for Acute Medicine (JAAM) is an academic association and a suborganization of Japan Medical Association. In Japan, emergency medicine specialists who treat critical patients exclusively were the byproducts of the advent of tertiary emergency centers. Acute medicine naturally covers a wide range disciplines, from basic sciences and clinical medicine to sociomedical considerations. These facts, as well as the presence of JAAM, have contributed to the creation of the new multidisciplinary clinical science of "pantraumatology." Despite the progress in acute medicine over the last several years in Japan, important future tasks include the support and dissemination of emergency medical research, improved organization in the emergency care system, and standards for general clinical competency of emergency specialists at all levels.

Education, Medical

[In France, school health education].

Since 1976 health education has been incorporated in most school programmes at various levels, from the kindergarten (3 years) to the end of high school (16 years). In kindergarten and at primary level health education belongs to a series of activities called d'éveil meant to sharpen the interest of the child in the social, cultural and artistic fields. At secondary level, health education, though not an autonomous discipline, is usually incorporated in courses of natural sciences or biology. There are also specific health education activities when an entire form spends a month by the sea shore or in the mountains. To help teachers in their task the French Committee for Health Education produces every year teaching material specially conceived for different age groups. The main subjects dealt with concern oral health, the prevention of home accidents, nutrition, smoking control and the promotion of health. The various activities of the French Committee for Health Education have revealed new needs which concern the training of teachers, change in mentality and improved coordination.

Child

Some comments on teaching biostatistics in medical and health sciences.

The role of statistical methods is now well recognized in health sciences since these disciplines are concerned with the study of communities or populations where the principles of sampling and statistical inference are clearly applicable. However, many medical and health sciences teachers and students have been slower to perceive the need for knowledge of biostatistical methods, even though all aspects of medical diagnosis and prognosis are governed by the laws of probability. Some of them are still skeptical about the value and importance of biostatistical principles to their fields and raise questions about the meaning, content, and nature of biostatistics and relevance of its teaching to health sciences disciplines. The purpose of this essay is to address some of these issues with the hope to invoke comments and responses from other biostatistics instructors who have encountered similar predicaments in their teaching and consulting roles to health sciences students and professionals.

Biometry