Knowledge for the good of the individual and society: linking philosophy,disciplinary goals,theory, and practice

Nursing as a profession has a social mandate to contribute to the good of society through knowledge‐based practice. Knowledge is built upon theories, and theories, together with their philosophical bases and disciplinary goals, are the guiding frameworks for practice. This article explores a philosophical perspective of nursing's social mandate, the disciplinary goals for the good of the individual and society, and one approach for translating knowledge into practice through the use of a middle‐range theory. It is anticipated that the integration of the philosophical perspective and model into nursing practice will strengthen the philosophy, disciplinary goal, theory, and practice links and expand knowledge within the discipline. With the focus on humanization, we propose that nursing knowledge for social good will embrace a synthesis of the individual and the common good. This approach converges vital and agency needs described by Hamilton and the primacy of maintaining the heritage of the good within the human species as outlined by Maritain. Further, by embedding knowledge development in a changing social and health care context, nursing focuses on the goals of clinical reasoning and action. McCubbin and Patterson's Double ABCX Model of Family Adaptation was used as an example of a theory that can guide practice at the community and global level. Using the theory‐practice link as a foundation, the Double ABCX model provides practising nurses with one approach to meet the needs of individuals and society. The integration of theory into nursing practice provides a guide to achieve nursing's disciplinary goals of promoting health and preventing illness across the globe. When nursing goals are directed at the synthesis of the good of the individual and society, nursing's social and moral mandate may be achieved.     

Albert Mieczysław Krąpiec’s theory of the person for professional nursing practice

This article presents the works of great Polish philosopher, Mieczys?aw Albert Kr?piec, whose creative output can be applied to professional nursing practice. Kr?piec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Kr?piec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Kr?piec: the theory of the person based on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Kr?piec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all—not only selected—qualitative deficits of characteristics can be defined as holistic care in the nursing profession.     

Nursing as concrete philosophy,Part I: Risjord on nursing knowledge

This essay addresses the problem of the essentiality of nursing knowledge and what kind of theory, if any, is essential to nursing practice. The overarching aim of the essay was to argue for the thesis that nursing may be described as a kind of philosophical activity, and, consequently, that philosophy is the kind of “theory” that is essential to nursing practice and to the nursing discipline at large. The essay consists of two papers. The present paper, Part I, is a critical examination of Mark Risjord's discussion of the problem of the theory‐practice gap in his Nursing Knowledge: Practice, Science, Philosophy, from 2010. According to Risjord, the cause of the theory‐practice gap originates in an erroneous conception of science (logical positivism) which had a decisive influence upon the way nursing scholars appropriated theoretical frameworks for the nursing discipline. This philosophical influence is considered in effect to have generated the theory–practice gap. In order to bridge the gap, Risjord suggests, the nursing discipline needs to adopt a standpoint epistemology conjoined with a postpositivist conception of scientific theory. In this way, a legitimate brand of nursing science may be developed and the theory–practice gap overcome. I will argue that neither Risjord's diagnosis of the problem, nor his recommended cure, may succeed in rescuing the nursing discipline from the theory–practice gap. Rather, the real cause of the theory–practice gap, I will claim, derives from an erroneous conception of nursing (not of science), namely the conception of nursing as a kind of science (roughly speaking). On my view, to overcome the gap, the nursing discipline needs to make salient the inherently philosophical character of nursing. In the second paper (Part II), I will continue the discussion of nursing knowledge and delineate the thesis of nursing as a kind of concrete philosophy.     

Exploring the use of feminist philosophy within nursing research to enhance post-positivist methodologies in the study of cardiovascular health

Abstract  Nursing has historically relied heavily on scientific knowledge. It is not surprising that the cardiovascular health literature has been highly influenced by the post-positivist philosophy. The nursing discipline, as well as the cardiovascular nursing speciality, continues to benefit from research grounded within this philosophical tradition. At the same time, there are limitations associated with post-positivism. Therefore, it is beneficial for researchers and clinicians to examine the potential contributions various philosophical traditions can have for their research and practice. This paper is an exploration of the compatibilities of feminist and post-positivist philosophies in the study of cardiovascular nursing research. The ensuing discussion entails an examination of my clinical and research interests, the grounding of my research within the post-positivist perspective and the significant contribution feminist philosophy can make to my research.     

What nurses of color want from nursing philosophers

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. Five nurse scholars of color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge.     

Self-transcendence: Lonergan's key to integration of nursing theory, research, and practice

Abstract This paper proposes that the philosophy of Bernard Lonergan can provide insight into the challenge of integrating nursing theory, research and practice. The author discusses Lonergan's work in regard to reflective understanding, authenticity and the human person as a subject of consciously developing unity. This is followed by a discussion of two key elements in Lonergan's work that relate to nursing: the subject–object challenge of nursing inquiry and common sense vs. scientific knowledge. The author suggests that integration of nursing theory, science and practice may be achieved through self‐transcendence.     

Whither nursing philosophy: Past,present and future

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25^th conference of the International Philosophy of Nursing Society 16^th August 2022. Using the literary meaning of ‘whither’, that is ‘to what place’, this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led to where it sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners.     

A Gadamerian approach to nursing: Merging philosophy with practice

Philosophy is commonly criticized for being too abstract and detached from practical spheres. Upon chronicling how philosophy has gained this reputation, the authors explore the philosophical fields of phenomenology and hermeneutics that have explicitly attempted to merge philosophy with everyday life contexts. In recent decades, phenomenology and hermeneutics have been applied to healthcare. In the realm of nursing, Patricia Benner's nursing theory is especially informed by phenomenology, which is briefly explored through her relationship with one of her mentors, the philosopher Hubert Dreyfus. The authors then turn their attention to Hans-Georg Gadamer's philosophy in an attempt to mine concepts relevant to the practice of nursing. Gadamer juxtaposed the human sciences from the natural sciences and thought that both needed different approaches: whereas natural sciences are guided by episteme, that is, universal knowledge, human sciences are guided by phronesis, that is, practical wisdom. Gadamer's philosophy is especially helpful in understanding how to cultivate phronesis in nursing wherein a nurse relies upon one's clinical experience to masterfully navigate each unique patient relationship. Nurses must serve as authorities in the realm of healthcare but also be open to the authority of their patients, who ultimately choose their course of treatment in our contemporary era of patient autonomy. Gadamer's philosophy can help us understand why phronesis requires not only practice but also reflection on that practice to be appropriately cultivated. The authors apply this to the realm of nursing in showing how both practice—clinically and via simulation—and reflection—through journaling or dialogue—are necessary for phronesis to emerge.     

A comprehensive theory of the human person from philosophy and nursing

This article explores a problem of the articulation of an adequate account of the human person in both philosophical and nursing theory. It follows the lead of philosopher Norris Clarke in suggesting that there has been a significant division in the way philosophers have looked at the human person and goes on to suggest that this division is paralleled in prominent nursing theories. The paper reviews and argues for the synthesis of two contemporary philosophic theories of the person that arise from the traditional philosophical division, and uses Clarke's account to show the ontological need for such a synthesis if we are to have a more adequate account of the human person. Next, accounts of the person identified in a number of the prominent theories of nursing are briefly reviewed revealing the vast complexity of the person encountered in nursing practice. It is suggested that each new theory of nursing is founded, at least in part, on the need to account for attributes of the person missing from prior nursing theories. It will be seen that the synthesized account of the person argued for here more adequately accounts for the various attributes identified in these nursing accounts and it is hoped that this synthesized account will serve as a somewhat more complete basis for a continued exploration of the persons encountered in nursing practice in its many and varied manifestations.     

Resisting the muddy notion of the ‘Inclusionary Other’: A re/turn to the philosophical underpinnings of Othering's construction

The notion of ‘Inclusionary Othering,’ in garnering uptake within diverse nursing spheres, muddies a critical understanding of Othering by obscuring the colonial production, exploitation and perpetuation of the Other for economic and political gain. The ongoing genocide of Indigenous women and girls in Canada is a direct manifestation of the Othering process and in response to the report's Calls for Justice, it is an apt time to re-enliven the conversation of the process of Othering's philosophical construction. The purpose of this article is to re/turn to the philosophical underpinnings of the process of Othering in hopes of enlivening a new wave of resistance within nursing and elsewhere to the means by which the Other is constructed as well as to the notion of Inclusionary Othering itself. Perhaps this re/turn to the philosophy of Edward Said and Sylvia Wynter can result in further thwarting the Othering construct by highlighting its colonial construction and usher in a pragmatic shift, increasing critical engagement with the construct as well as inspiring a re/newed resistance toward Othering in nursing practice.     

Freedom to roam: a Deleuzian overture for the concept of care in nursing

From a position informed by the philosophical legacy of Gilles Deleuze and Felix Guattari, this paper examines the idea of ‘care’ in nursing theory and philosophy. Deleuze and Guattari make a distinction between, on the one hand, ‘concepts’, which are the proper domain of philosophy and, on the other, ‘functives’ which are the domain of science and all other empirical matters. At first blush, this distinction and use of the word concept appears rather odd, but Deleuze and Guattari hold it to be important for reasons that go beyond the acknowledged and obvious differences between philosophy and science. In Deleuzian terms, a ‘functive’ is any proposition that makes a verifiable truth‐claim about actual states of affairs, whereas a ‘concept’ is a philosophical tool that, although it is used in statements that make claims and that seek to affect our thinking on states of affairs, is not a representation of them in any verifiable (functive) sense. In this respect, philosophical concepts, and the statements in which they are used, are neither true nor false. I argue that the way in which the word ‘care’ is used in much nursing theory and philosophy conflates concept (neither true nor false) with functive (either true or false) with less than productive results. I seek to persuade that if we can gain more clarity between the use of care as a would‐be functive and its use as a philosophical concept, this would strengthen the purpose of the use of the idea of care in nursing theory. This is to say that I take the view that the role of ‘care’ as a philosophical concept is to be used in statements that ‘think the event’ called nursing; that seek to be ‘worthy of the event’, but without being an actual part of the event. Finally, I show how the concept of care in nursing philosophy has been, and can continue to be, reworked to achieve the permanent task of surveying the ever‐shifting planes of the event and how it is described.     

Philosophy of technology and nursing

Abstract This paper outlines the background and significance of philosophy of technology as a focus of inquiry emerging within nursing scholarship and research. The thesis of the paper is that philosophy of technology and nursing is fundamental to discipline development and our role in enhancing health care. It is argued that we must further our responsibility and interest in critiquing current and future health care systems through philosophical inquiry into the experience, meaning and implications of technology. This paper locates nurses as important contributors to the use and integration of health care technology and identifies nursing as a discipline that can provide specific insights into the health experience(s) of individuals, cultures and societies. Nurses are encouraged to undertake further examination of epistemological, ontological and ethical challenges to arise from technology as a focus of philosophical inquiry. The advancement of philosophy of technology and nursing will make a profound contribution to inquiry into the experience of technology, the needs of humanity and the development of appropriate health care.     

Towards a strong virtue ethics for nursing practice

Abstract  Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the 'therapeutic' or 'helping' nurse–patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions , nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics' action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.     

Bringing critical realism to nursing practice: Roy Bhaskar's contribution

In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complexities of the social world. In recent evidence from healthcare literature, there has been a surge in research using realist methodology (realist evaluation and realist synthesis), which is underpinned by the philosophy of critical realism and which offers a different perspective to understanding nursing and healthcare problems through the realist lens. However, we suggest that sufficient attention is not always paid to the philosophical roots of this methodology. In this paper, we provide insight into Bhaskar's work and demonstrate how research positioned within critical realism and realist methodology can advance nursing and healthcare‐related knowledge. Through shining a light on Bhaskar, we illustrate how critical realism philosophy is a natural fit with human and health science enquiry, including nursing.     

Understanding ‘caring’ through biopolitics: the case of nurses under the Nazi regime

These days, discussions of what might be the ‘essence’ or the ‘core’ of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the ‘newer’ nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of ‘life unworthy of living’. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; ‘goodness’ that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.     

The practice of phenomenology: The case of Max van Manen

Since its inception, phenomenological philosophy has exerted an influence on empirical science. But what is the best way to practice, use and apply phenomenology in a non‐philosophical context? How deeply rooted in phenomenological philosophy must qualitative research be in order to qualify as phenomenological? How many of the core commitments of phenomenology must it accept? In the following contribution, I will take a closer look at Max van Manen's work. I will argue that van Manen's understanding of and presentation of phenomenology is quite problematic and that his book Phenomenology of Practice rather than amounting to a clear and accessible presentation of the phenomenological method that would make it do‐able to researchers who are not themselves professional philosophers is in fact both abstruse and excessively complicated. I will then turn to nursing, and by taking that as my example, outline a better way to apply and practice phenomenology.     

Through the lens of Merleau-Ponty: advancing the phenomenological approach to nursing research

Abstract   Phenomenology has proved to be a popular methodology for nursing research. I argue, however, that phenomenological nursing research could be strengthened by greater attention to its philosophical underpinnings. Many research reports devote more page space to procedure than to the philosophy that purportedly guided it. The philosophy of Maurice Merleau-Ponty is an excellent fit for nursing, although his work has received less attention than that of Husserl and Heidegger. In this paper, I examine the life and thought of Merleau-Ponty, with emphasis on concepts, such as perception, intentionality and embodiment, which have particular relevance to the discipline of nursing.     

Parallels in practice: palliative nursing practice and Parse's theory of human becoming

Nurses experienced in the art and science of palliative nursing will find many elements of congruence between the principles and philosophy of palliative practice and the theory of human becoming. In this brief exploration of parallels in practice between Parse's theory of human becoming and traditional palliative and hospice nursing practice, the author suggests that the theory of human becoming is consistent and consonant with the values that shape palliative nursing practice. The theory is briefly described, and four parallels of practice are identifed: whole person care; the presence of paradox in human experience; primacy of the person; and presence and dialogue, or "being with, " dying persons. The theory of human becoming holds relevance and promise in its capacity to provide palliative and hospice nurses with a theoretical framework with which to inform and guide nursing practice with dying persons.     

The relevance of Xenophon’s Anabasis and Plato’s Meno to nursing

The current situation in which the humanities are disparaged affects all university disciplines, including nursing, in whose historical evolution the humanities have always been present in one form or another. Looking beyond this disrepute, this study proposes that nursing renew its attention to classical philosophy. Specifically, it invites a close reading of Xenophon's Anabasis and Plato's Meno, to get three related goals: to show how the use of ancient texts are very valuable tools for the philosophical initiation of nursing students and can help them reflect on their choice of nursing as a practical activity; to reflect on the problem of virtue and the nature of the good life; and to show how the interaction with ancient texts allows students to reflect on questions and issues of life, theirs and others, that are not open to investigation through a purely scientific method. Consequently, both Anabasis and Meno readings strengthen the intellectual relationship between philosophy and nursing, enabling the latter to delve deeper into the key questions of its own thought as a discipline.