Lying to ourselves: rationality, critical reflexivity, and the moral order as ‘structured agency’

Abstract

A report suggests that United States' army officers may engage in dishonest reporting regarding their compliance procedures. Similarly, nurses with espoused high ethical standards sometimes fail to live up to them and may do so while deceiving themselves about such practices. Reasons for lapses are complex. However, multitudinous managerial demands arising within 'technical and instrumental rationality' may impact on honest decision-making. This paper suggests that compliance processes, which operates within the social structural context of the technical and instrumental rationality manifest as 'managerialism', contributes to professional 'dishonesty' about lapses in care, sometimes through 'thoughtlessness'. The need to manage risk, measure, account, and control in order to deliver efficiency, effectiveness, and economy (technical rationality) thus has both unintended and dysfunctional consequences. Meeting compliance requirements may be mediated by factors such as the 'affect heuristic' and 'reflexive deliberations' as part of the 'structured agency' of nurses. It is the complexity of 'structured agency' which may explain why some nurses fail to respond to such things as sentinel events, a failure to recognize 'personal troubles' as 'public issues', a failure which to outsiders who expect rational and professional responses may seem inconceivable. There is a need to understand these processes so that nurses can critique the context in which they work and to move beyond either/or explanations of structure or agency for care failures, and professional dishonesty.

Information systems in nurses' work: Technical rationality versus an ethic of care

“…Donald Schön (1983) saw technical rationality as restricting one to the use of a single type of knowledge, preferably scientific, to solve problems, instead of using that knowledge as one component in a reflective practice. Thirty years later, Goodman (2016) conceptualised technical rationality in late modern society, not as decision-making, but as rule-following, without asking for the aim of the rules. He argued that technical rationality in our society requires 'thoughtlessness', that is, that the space for individual, creative decision-making has declined.…”

“…Nurses can either adapt to the overall rationalities of the hospital, or they can try to add the requirements posed by technical rationality to what they perceive as the core of their work. According to Goodman (2016), nurses may feel uncomfortable when their basic professional ethics conflict with the organisational ethos, but they are normally not able to articulate the root of the problem. Instead, there is general dissatisfaction and sometimes subtle noncompliance with the organisational regulations (Dupret, 2017).…”

“…The technical rationality that nurses were expected to engage in was not only independent means-to-ends thinking, but often following processes that were built in the computer systems in a Tayloristic manner (cf. Goodman, 2016). The systems also facilitated the surveillance of the nurses.…”

“…The nurses in the study tried to hold on to their ethic of care but felt that it was increasingly difficult to do so; although they reacted to this with resilience rather than with resistance. As Goodman (2016) suggests, they did not formulate their problems by articulating the different interests of the management, the IT providers and themselves, in a way that would have served as a platform for action. Rather, they seemed to comply unwillingly to the realisation that working according to ethics of care was becoming less and less valued (Wilson, 2004).…”

Read it in books: Literary fiction as a tool to develop moral thinking in the educator

“…Our position is not that the arts may be a valuable mechanism, or tool to use when 2 educating -others have addressed this -rather, that they also have the power to transform the view of the academic by helping her to think differently about the world, to resist taken for granted commonplaces and to see beyond the everyday ideology and dogma of teaching and learning. For us, the humanities may productively be drawn upon as an antidote to the observation that nurse education may be slouching toward a task-based instrumentalism, which devalues scholarship of the kind that was once a cornerstone of a broad liberal education and which, driven by a culture of technical rationality, has more in common with training than with education (Goodman, 2013(Goodman, , 2016Grant, 2014Grant, , 2019Darbyshire et al, 2019). We see the humanities as a potential counterbalance to this, which educators might draw upon in order to develop the moral insight required to resist and present an alternate position especially in relation to some of the darker problems facing our profession such as incivility, poor care, intolerance and lapses in professionalism.…”