Philosophy is defined as the study of the basic principles and concepts of a particular branch of knowledge; embracing and seeking wisdom through reason and the logical presentation of ideas. This concept, I believe, is to strip an idea down to its fundamental basis or theory, analyzing cause rather than effect, then through investigation and exercise, begin to find understanding. When this concept is applied to an existing practice, all parties benefit from an equal and larger pool of knowledge. As a nurse, I see firsthand how philosophy applies to my profession. How do we define nursing as a practice? After reviewing many journals and textbooks, I found one statement that defines nursing as I see it. Ramona T. Mercer, who is known for her Maternal Role Attainment theory, states that the three major foci for nursing are, “health promotion and prevention of illness, providing care for those who need professional assistance to achieve their optimal level of health and functioning, and research to enhance the knowledge base for providing excellent nursing care. ” (Alligood, 2009, p.586)
I believe that these three applications stem from the following ideals: family values, happiness, sense of accomplishment, honesty, and responsibility. In order to succeed at these applications, there must be a balance between practice and concern. There are three major branches of philosophy, natural philosophy, metaphysical philosophy, and moral philosophy. When speaking of nursing philosophy, it is the moral aspect that comes into play most, driving guiding and defining the practice. This paper will address the theme of the Philosophy of Nursing. I will define nursing as a whole and discuss its primary goals, discuss the aspect of nursing as an art or science, and introduce theory and how it pertains to the philosophy of nursing. I will then discuss how this philosophy relates to me, how my morals and ethics are shaped by not only knowledge, but belief as well.
Primary Goal of Nursing
Nursing is a profession steeped in rich values based on the work of Florence Nightingale. This profession has not degraded over time due to the character of the individuals that commit to this career. It is reasonable to think that each of us chose nursing because of some key beliefs or values that we possessed. These values and beliefs ultimately guide us in formulating our own definition of nursing and what we believe to be its primary goal. Friberg (2011) related to this quote from Florence Nightingale (1860) “put the patient in the best condition for nature to act upon him”. This essence of nursing practice continues to be reflected in contemporary nursing. My personal goal in nursing is to give the greatest care with the best of my ability to a patient and his family. To do this, I make a commitment on my part to keep myself up to date with new technologies, evidence-based research, and new protocols, and, to trust in my moral philosophy and beliefs in order to put these tools to best use.
Nursing is an Art and a Science
Scholars have debated for years over the perception of nursing as an art or a science. Those closer to the field see nursing more as an art form; working through medium, process, and product. Those who look at nursing from the outside, however, tend to view nursing more of a science; practice through systematized knowledge and exercise. For much of the history of nursing, the argument has stemmed from the idea of which practice is most beneficial. First, let’s address nursing as an art. The pioneer’s theorists such as Florence Nightingale are referenced as practicing the art of nursing as it pertains to compassion, feelings, trust, and performing tasks with skills. Each of these ideal is a foundation to the next; without caring the nurse cannot connect with the patient, if the nurse cannot connect, trust will not develop, without this trusting relationship, therapeutic nursing cannot take place. Therefore, caring is at the center of all-successful nursing encounters. In her book Novice to Expert Benner states, “One way to separate the instrumental and expressive aspects of nursing is to regulate caring as the art of nursing (Benner, 1984, 170).
Also, the art of nursing is the ability to form trusting relationships, perform procedures skillfully, prescribe appropriate treatments, and morally conduct nursing practice (Johnson, 1994). As important as the art is, however, it relies on the science to guide it; as a hand guides a brush to canvass. Now, let’s address nursing as a science. The nurse should have knowledge in biology, chemistry, pathology and current guidelines for pharmacological therapy. This is an ever-changing body on knowledge. Science also encompasses the skill required to perform technical tasks. Benner’s Novice to Expert model explains the science behind skill acquisition.
As nurses we are all on a continuum to achieve “expert” in each of the seven domains of competencies. Science makes up the foundation for current practices exercised in nursing. It shapes and drives this practice through knowledge, understanding and technology. However, the science of nursing can only be applied through the art of the practice; especially in a field where case are seldom similar. I believe that, in order to be a successful nurse, one must be able to provide the “art” of caring through form, as well as continuing to obtain knowledge, or “science”, through function. The balance of these two styles is essential to providing optimal treatment; each encourages the other.
Roles that Theory plays in my BN Nursing Practice
The study of existing theories provides framework and guidelines for the nursing field; and it has since as far back as Florence Nightingale in 1850’s. Each of the many theories, as taught in the Bachelor of Nursing program, has something different to contribute to nursing, depending on which area of health care it is applied to. That is not to say that we, as nurses today, cannot think outside of the boundaries of these theories; technological advancement, scientific breakthroughs, and persistent research are ever-changing the way we understand our practice. Theory should be used as the groundwork of which all other teachings are built upon; by studying the past, we are more prepared for the future. The foundation of nursing theories is based on knowledge which is gained through four ways of knowing: empiric, ethics, esthetics, and personal, according to Carper (1978).
By building upon the fundamentals learned from obtaining a nursing diploma, my undergraduate education in nursing (BN) gives me the additional tools necessary to establish my nursing practice. Through the study of established methods and practical training (empirically and esthetically), I have laid a strong foundation for practice and exercise. Through observation and experience (ethically and personally), I continually expand my critical thinking and improve ability with my newly acquired knowledge. Once these theories are established, we use reasoning to be able to formulate them into research, practice, and philosophies.
The three most common methods of reasoning are deductive, inductive, and abductive as stated by Johnson (2010). For most of my nursing career, I have relied on abductive reasoning and intuition, as I have worked in varied intensive care units. Because circumstances vary greatly from patient to patient and case to case, we can never assume an outcome based solely on previous situations. It is in these experiences where common theories are shaped into our personal philosophies.
Nursing Practice as it relates to my philosophy?
As I research this paper, I reflect back with a fresh perspective on the nursing theorist past and present. Having been a nurse for many years now, I find that my views and beliefs I held at the beginning of my career differ greatly from those I keep today; whereas early on I supposed that nursing was primarily based on assessment and exercise, now I find that personal values and belief are just as important as practice. Teachers and mentors established a base for nursing philosophy; however, my experiences, both good and bad, have helped shaped my own. I have come to understand and relate to Florence Nightingale’s approach to nursing, placing caring at the center of all practice. My philosophy is based on key values that place care of the patient foremost: honesty, trust, empathy, advocating, education, observation, and responsibility. Honesty, trust and empathy are important for me to be able to establish a relationship with the patient. Education and observation are important in be able to provide the best care available; and in worst case scenarios, providing comfort.
Advocating is important when the patient is not able to speak for themselves. And finally, we have responsibility. Responsibility drives me to be ever improving and learning so that I can be assured of providing the best possible care. All of which are reliant on the others. Having 22 years of intensive care experience taught me a great deal about myself. There were situations where I felt extremely vulnerable and ineffective, such as dealing with aggressive or confused patients that basically rendered me emotionally distraught for some time after the events. In that situation, I needed to learn coping mechanisms to deal with the situations or needed the support of my colleagues to trade with me or help me when those times got tough. We all need to support and help each other get through our tough days. Ethical issues are a current component of health care. A sound personal nursing philosophy is required to deal compassionately and comfortably with issues such as medical futility, allocation of resources, withdrawal of treatment, use of restraints, caring for homeless people, etc.
This also means that we are consummate advocates for the patient and willing to speak up when we do not feel the environment is as safe as it can be. For me, investigation and development of my own nursing philosophy is a prerequisite for a meaningful life and a fulfilling career in nursing. I believe we should be our patient advocate, especially in the intensive care unit where the patients are very vulnerable, and unable to speak because they are sedated, unconscious, or intubated. I face challenges every day at work to the best care I can give to my patients. On one of those days, I was taking care of an elderly patient who had been hospitalized in the ICU for a prolonged stay and she was on life support. Her condition was not improving and the family was asked to make a decision about withdrawal of treatment, but the family was afraid of the guilt and responsibility for her death. This family needed reassurance that everything had been done to improve the patient‘s condition but with no success. I sat down with them to explained what withdrawal of treatment meant.
After our discussion, the family understood that by removing the machines, we were allowing natural death to occur. This was the key decision factor because they originally thought they were killing the patient by removing the life support. After our discussion, the family agreed to remove life support and to initiate comfort measure. I believe everyone is entitled to quality of life and when we have exhausted all possible treatment, remove life support while keeping the patient comfortable. Personal experience is a very important influence in developing one’s philosophy of nursing. It adds diversity to known ideals which, in turn, increases the collective knowledge pool and improves nursing as a whole. But, however great the benefits might be, each philosophy must still adhere to the practice standards of their work place, and the regulations set by their nursing order. I believe my philosophy of nursing clarifies the requirements in knowledge, human values, and technical skills so they can be organized, analyzed and evaluated.
Throughout my career, I have constantly been evolving my philosophy. Each case, each patient, each experience, all contributing insight to who I am and what kind of nurse I want to be. Through it all, though, the one nursing theory that I relate to the most and the keystone of my nursing philosophy, is listed by Dr. Moyra Allen (1987) in the McGill model; health, family, collaboration, and learning. At the beginning of my career, I was working at Royal Victoria Hospital which is now part of the McGill University Health Center.
I remember using a primary nursing care concept. It is basically continuity of care; same nurses are assigned patients from their admission to their discharge. It gave the nurse an opportunity to participate with the multidiscipline team about the patient’s care, and incorporate the family. I have always believed that that family needs to be incorporated into our care of patients. Too many times, I have seen nurses go in and out of patient’s room without interacting with the family or ignoring them. Families are a big part of the McGill model and in my own nursing practice.
My philosophy of nursing takes into consideration the elements of nursing practice which are the beneficiaries of care, their family, health/illness, and the society around them. It shapes my life and drives my daily experience as I interact with my family, strangers, my environment, and society around me. As our knowledge increases our philosophy grows; the two becoming tightly woven about one another and becoming ultimately inseparable. It is very difficult to face the demands of caring for people from day to day without the solid foundation of a personal philosophy. We are more effective in anything that we do when we understand ourselves, the way we think, and where our values are in reference to others as well as our personal strengths and limitations.
This paper provided a different and valuable perspective for reinterpreting my knowledge on concepts, theories, and philosophy in nursing. It was interesting to document my journey as I reflected on my philosophy of nursing and my career as an intensive care nurse. Our own values and beliefs must be clarified in order to authentically respond to the health care needs of our patients and to society as a whole. The main reason I chose this profession was because of the endless possibilities that are available to care for people. As an ICU nurse, my duties entails patient and family care, educating and mentoring new and fellow nurses, and assisting with policy and procedures. We need to rid society of the totally false dichotomy that nurses are either highly educated or caring.
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