Bates  Discussion  Questions,  Chapter  10    10.1  Two  insights  on  the  definition  of  sustainability,  first  from  an  environmentalist  perspective,  the  second  from  the  medical  perspective:    

The  increasing  scale  of  human  activity  on  the  planet  has  led  to  the  emergence  of  sustainability  as  a  central  aim  for  society.  In  its  most  basic  form,  sustainability  can  be  defined  as  the  ability  to  sustain  (Kajikawa,  2008),  maintain  (Lele  and  Norgaard,  1996  and  Marcuse,  1998),  or  continue  (Dempsey  et  al.,  2011  and  Shearman,  1990)  something  over  time.  Historically,  the  term  has  been  used  in  a  technical  sense  within  specific  disciplines  to  refer  generally  to  the  maintenance  or  continuation  of  some  process  or  system  over  time  (Kajikawa  et  al.,  2007).  Today,  sustainability  is  an  issue  of  concern  primarily  because  of  the  mounting  evidence  to  suggest  that  human  activity  in  the  Earth  system  is  following  an  unsustainable  trajectory.    

Hay,  L,  A  Duffy,  and  RI  Whitfield.  "The  Sustainability  Cycle  And  Loop:  Models  For  A  More  Unified  Understanding  Of  Sustainability."  Journal  Of  Environmental  Management  133.(n.d.):  232-­‐257.  Science  Citation  Index.  Web.  2  July  2014.  

 Reforms  aimed  at  balancing  cost  with  benefit  are  increasing  instabilities  in  health  care  (Fonck  et  al.  2001,  Orszag  2011)  and  the  concept  of  sustainability  has  never  been  so  important.  It  is  of  no  surprise,  then,  that  health  care  and  nursing  have  embraced  the  concept.  In  times  of  fiscal  restraints,  healthcare  organizations  have  sought  advice  from  the  discipline  of  management  (Carlson  et  al.  2010)  seeking  how  best  to  restructure  healthcare  organizations  facing  increasing  populations,  increasing  healthcare  demands  and  dwindling  resources.  Inevitably  the  question  remains,  how  are  healthcare  systems  to  be  sustained  without  cutting  services?  This  is  an  important  and  timely  question,  impacting  local,  national  and  international  health  service  delivery  plans.  

 McMillan,  K.  "Sustainability:  An  Evolutionary  Concept  Analysis.  

Exploring  Nursing's  Role  Within  The  Sustainability  Movement."  Journal  Of  Advanced  Nursing  70.4  (n.d.):  756-­‐767.  Science  Citation  Index.  Web.  2  July  2014.  

 Duffy  and  Whitfield  are  considering  sustainability  through  the  classically  understood  frame  of  environmental  responsibility  and  life/lifestyle  maintenance.  McMillian,  on  the  other  hand,  is  considering  sustainability  through  the  much  more  narrowly  circumscribed  lens  of  continuing  production  of  medical  care.  The  concepts  are  the  same  (in  so  far  as  the  word’s  definition  is  not  changed  in  application)  but  the  

contextual  meaning  is  entirely  different.  However,  the  concept  is  applied,    the  word  does  not  change  in  meaning,  and  in  fact,  the  relative  idea  of  continuation  of  life  is  clearly  present  in  both  contexts.        10.2    Both  Duffy  and  Whitfield  and  McMillan  share  three  basic  assumptions  about  reality:    ontologically,  they  share  an  anthropocentric,  rational-­‐agent  view  of  reality;  epistemologically,  they  share  a  value  system  that  centers  around  human  flourishing,  the  long-­‐term  satisfaction  and  well-­‐being  of  all  human  beings,  and  both  articles  profess  a  deep  and  remarkably  value-­‐laden  orientation.  Duffy  and  Whitfield  believe  that:    

In  spite  of  the  considerable  research  on  sustainability,  reports  suggest  that  we  are  barely  any  closer  to  a  more  sustainable  society.  As  such,  there  is  an  urgent  need  to  improve  the  effectiveness  of  human  efforts  towards  sustainability.  

 McMillan,  similarly,  believes  that  it  isn’t  application  that  is  needed,  so  much  as  is  understanding.  She  writes  that:  

The  concept  of  ‘sustainability’  emerged  in  the  1950s  as  a  result  of  the  environmental  movement.  The  concept  has  been  adapted  by  the  discipline  of  management  and  is  increasingly  discussed  in  the  context  of  health  care.  The  concept  remains  ambiguous  in  the  discipline  of  nursing,  resulting  in  a  struggle  to  articulate  the  role  of  nursing  in  the  sustainability  movement.  

 And  later,  

The  profession  of  nursing  claims  no  geographical  boundaries,  working  in  diverse  areas  of  health  care.  These  range  from  outpost  and  global  nursing  to  areas  in  policy  development.  Such  diverse  job  profiles  position  nursing  at  the  heart  of  the  sustainability  movement  in  health  care.  However,  the  concept  and  its  implications  for  the  profession  remain  ambiguous.                

   

sus·tain·able  adjective  \sə-­‐ˈstā-­‐nə-­‐bəl\  :  able  to  be  used  without  being  completely  used  up  or  destroyed  :  involving  methods  that  do  not  completely  use  up  or  destroy  natural  resources  :  able  to  last  or  continue  for  a  long  time  

 

10.3     Duffy  and  Whitfield:     McMillan:    Concepts   Historicism     Term-­‐orientation  Assumptions   Historical  understanding  

leads  to  future  successes  Clear  definitions  lead  to  clear  outcomes  

Insights/  Arguments   “Humans  seek  sustainability  via  an  iterative  process  of  interpretation  and  action.”  

“‘Sustainability’  is  a  fragile  concept  highly  dependent  on  the  processes  and  stakeholders  involved  in  its  fruition.  There  is  a  distinct  difference  in  the  level  of  concept  clarity  between  the  disciplines  of  management  and  nursing.”  

 10.4     Duffy  and  Whitfield:     McMillan:    Concepts   Global  Warming  is  caused  

by  human  interference  Utilitarianism:  The  ends  (usually)  justify  the  means  

Assumptions   The  human  production  of  greenhouse  gasses  has  caused  (and  will  continue  to  cause)  severe  ecological  consequences    

Sustainability  is  not  process-­‐oriented,  but  outcome-­‐oriented.  

Insights/  Arguments   “The  Earth  system  may  be  viewed  as  a  socio-­‐ecological  system  …where  “society  and  nature  are  innately  coupled.”  As  such,  it  may  be  seen  that  humans  are  integral  components  of  the  system.  However,  they  may  also  intervene  in  the  system  and  its  sub-­‐systems.”  

“…the  discussion  of  sustainability  as  outcome  was  predominantly  derived  from  the  nursing  literature,  where  the  complexities  of  sustainability  efforts  have  not  be  recognized,  and  the  focus  was  on  outcome  by  means  of  programme  evaluation  research.”  

 10.5  While  conflicts  within  a  particular  discipline  may  be  discovered  by  considering  multiple  and  conflicting  theoretical  approaches  within  a  single  discipline,  such  conflict  analysis  does  not  necessarily  constitute  interdisciplinary  research  or  study.  The  same  basic  worldviews,  assumptions  and  concepts  are  present  within  a  single  discipline  regardless  of  slightly  conflicting  paradigms.