“We have to live today by what truth we can get, and be ready tomorrow to call it falsehood.”
Pragmatism as set out by authors such as William James and Charles Peirce and interpreted for the post modern age by writers like Richard Rorty and John Dewey7, has many common factors with the concept of childhood. In both childhood and pragmatism we understand that time, space and place are important. The quote above is an early statement indicating pragmatist recognises that our understanding about the world changes, just as our view of children as people changes as they move through childhood. Pragmatist like Richard Rorty recognise that the ideas held at one time in a certain place may have been useful to the people at that time 8, but just as our behaviours towards a three year old would not be appropriate demonstrated towards a 13 year old. Ideas and people change and our understanding changes too. This is then a rejection of much of Western European thought which, based on Plato ideas of schema, holds that there is a universal truth, one we might not have found yet but which is awaiting discovery.
In Pragmatic Children’s Nursing there is no “right way” to do children’s nursing. Instead we have to attend to the doubts or meanings which are raised in clinical practice. In the figure below I use the example of whether children’s carers can report on the subjective experience of pain. Doubt is an uncomfortable condition so as humans we tend to want to resolve doubt into beliefs or to find meaning in the situation. By reading various research studies we can understand that children’s carers can not accurately report what a child themselves experiences9.The belief then leads to actions or intentions to act and behaviours in this case realising children are the only ones who can comment on their pain would lead to introducing a self report scale. John Dewey and his fellow pragmatist Quine considered the effects of language. What they concluded was that language only has meaning in groups who share the understanding of the language. The rather complex over lapping circles in the diagram below attempt to show the potential groups who share meanings via language and interaction in the triad between child-carer-nurse. Thus to return to our example introducing and using a self report scale for pain in children on a ward say would require the parties to share beliefs or meanings. Such a tool would not work if one party, say children themselves, did not believe that it was acceptable or useful. Thus the doubts raised the meanings or beliefs associated with these doubts might be seen differently by these groups A-G but could share aspects. More often than not the resolution of meaning or belief results in raising more doubts- What about nonverbal children, what about children who lack capacity?
Thankfully Pragmatism allows us to limit our questions or doubts by insisting that we only attend to the questions which will have an effect on the phenomena.