1. Witt, Catherine L.

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Difference of opinion leads to inquiry and enquiry to truth, and that, I am sure, is the ultimate and sincere object of us both. - -Thomas Jefferson

FIGURE. Catherine L.... - Click to enlarge in new windowFIGURE. Catherine L. Witt

For most of us, disagreements and conflict are something to be avoided. We are usually encouraged not to be argumentative and we certainly do not like to be challenged. It is unlikely that much time was spent in nursing classes debating the merits of one treatment plan over another, and while we might have spent a little time learning to review a research article, we most likely did not debate the quality of it with our professors. Unless we were on the debate team in high school, we likely did not learn the art of persuasive speech. Even more likely, we have not learned the art of listening with a goal of understanding the other's point of view.


We do not get a very good lesson from television, radio, or other forms of media either. In the United States, political disagreements are handled mostly by shouting, name-calling, and elaborate strategies to make sure that a particular political party wins. By making the opponent look "bad," we therefore make them "wrong." Instead of focusing on issues, the focus is the person, decreasing understanding of the issue and creating misinformation and intolerance of other viewpoints. There is not even a pretense of working together to come to some kind of agreement. The idea of negotiation and compromise is seen as being weak or giving in and considered political suicide.


In fact, the use of constructive controversy is an important tool in learning and in creating solutions to problems. Johnson defines creative controversy as a situation in which one person's "ideas, information, conclusions, theories, or opinions are incompatible with those of another and the two seek to reach an agreement."1(p30) There will naturally be conflict and cooperation in the process of reaching agreement, even if in the end we agree to disagree. More importantly, the process requires listening to the other person's viewpoint. It also requires taking time to research the topic, recognizing one's own preconceived notions, and creating a civil, persuasive argument for a particular point of view. It requires clarification of points that are not understood. It requires data on both sides. Most of all, it requires that we do not take other viewpoints personally.


One author sums up the basic mistakes we make in thinking about issues in 6 simple points.2


We prefer stories to statistics. Stories are a great way to learn and they touch an emotional part of us. One story, however, is just that one story. There can be many other stories illustrating the other side of an issue. It is important to look at the facts of an issue as well as the personal stories.


We seek to confirm, not to question, our ideas. Most people do not listen to talk radio hosts with whom they disagree. We like to hear people who confirm that we are right in our thinking. It is much more comfortable to talk to people whom we agree with. No conflict there. Not much learning either.


We rarely appreciate the role of chance and coincidence in shaping events. We do not have nearly the control we think we do over what happens. We like to know how and why something happens, so we sometimes connect cause and effect when it does not really fit.


We sometimes misperceive the world around us. Two people can look at an event in a completely different way. This is what makes eyewitnesses so unreliable. Our expectations and our personal preferences influence what we see and how we see it.2 Ask any parent to tell you who the best kid on the soccer team is.


We tend to oversimplify our thinking. The patients we care for have complex problems and the amount of information we have to deal with can be very overwhelming. Research does not always give us exact answers. If we can learn to discuss and debate issues rationally, it can lead us to solutions we might otherwise not think of. Imagine what could really be done with healthcare reform if both sides sat down, talked about it in a civil way, and came up with solutions that could really work.


Our memories are often inaccurate. Memory is tricky and subject to revision and often changes over time. Our perceptions of an event and our current experiences influence our memories of events. Ask the rest of your family how they remember holidays. It can be very surprising.


These basic mistakes in thinking demonstrate that we often make up our minds about a topic because we have heard a story or have listened only to opinions that match our own. We also do not realize that we may be missing part of the data or have a different perception of an event than someone else. It is unlike that we will learn much when we are stuck in this pattern of thinking.


In nursing, we talk a lot about critical thinking and how to teach it, how to get students to use it, and what it means. At the same time, we go through a lot of efforts to avoid controversy. We cannot be critical thinkers if we do not have the ability to look at more than one side of an issue and admit that our ideas or opinions might be only that-ideas and opinions. In fact, sometimes we may even be wrong. We must be able to question assumptions, be willing to be critical of our own viewpoints as well as others, and be able to listen to others who disagree with us.3 We also have to be able to articulate our viewpoint in a logical, calm, and respectful manner. If nursing (and society) is going to continue to progress, we have to be able to have rational discussions about difficult topics. Very few critical issues are solved through passive acceptance of information or by avoiding difficult discussions or by outshouting the other person.


When is the last time you went to a nursing conference and actually had an active discussion about research or an educational topic that is presented? As a rule, nurses are not very comfortable with debate. We do not like to be challenged or challenge one another. Unfortunately we lose a huge learning opportunity in this lack of debate. Becoming comfortable with civil, constructive controversy allows us to exchange ideas, hear other viewpoints, and come to a consensus that is possibly even better than where we started.


In this issue, we present 2 viewpoints of a sometimes ethically difficult diagnosis-Trisomy 18. Dr Bruns and Dr Catlin discuss different approaches to caring for these infants and point out various implications of those decisions. Many readers may have strong opinions about this on either side of the debate. However, the opportunity to learn comes from opening our minds to a different way of looking at an issue. You might not change your mind at the end but I encourage you to read both articles and think about this issue in a different way and from a different point of view than you usually do. Remember that we do not learn anything when we only take in information that confirms our point of view.


I would also like to draw your attention to the "Evidence Based Practice Brief" written by Whitney Hardy. This is a new feature that looks at current research and how we can apply that research to our current practice. We hope that you will find this useful. Even better, take it into your unit and have a (civil) debate in your next staff meeting.




1. Johnson D, Johnson R, Smith K. Constructive controversy: the educative power of intellectual conflict. Change. 2000;32(1):28-37. [Context Link]


2. Kida T. Don't Believe Everything You Think: The 6 Basic Mistakes We Make in Thinking. New York: Prometheus Books; 2006. [Context Link]


3. Leyshon S. Empowering practitioners: an unrealistic expectation of nurse education? J Adv Nurs. 2002;40:466-474. [Context Link]