Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever‐changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and (...) to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a ‘sound’ philosophy of nursing that will ‘accommodate diversity in nursing thought’. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be ‘sound’ in the sense that Kikuchi and Simmons use this term. In place of their call for ‘truth and unity in nursing thought’. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying ‘plausible narrative of progress’. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice. (shrink)

The concept of praxis, also known as the practical discourse in philosophy, has been expressed in different ways in different eras. However, the linkages from one era to another and from one paradigm to another are not well explicated in the nursing literature. Difficulties with translations of ‘praxis’ into ‘practice’ and the connotations of the word ‘practical’ in the English language and in nursing have influenced extrapolation of the linkages. More recently, further blurring of the linkages occurred from the popular (...) association of praxis within the emancipatory paradigm. Integral to the concept of praxis, since the time of Aristotle, is the notion of phronesis: a process of moral reasoning enacted to establish the ‘good’ of a particular situation, often referred to as practical wisdom. The purposes of this paper are twofold. Firstly to demonstrate a number of linkages and shifts in the evolution of praxis. This, I believe, will enhance understanding of the multiple expressions of praxis in contemporary nursing. Secondly, to promote and affirm the importance of praxiological knowledge development in the discipline. Furthermore, increased appreciation of the concept of praxis provides an important vehicle for the advancement of nursing as a moral endeavour and the nurse as moral agent. (shrink)

Western thought has dominated scientific development for a long time, and nursing has not escaped the influence of such ideology. Nurse scholars, in an attempt to fit the dominant scientific ideology, typically have had to struggle with non-empirical elements of nursing. This orientation in science, however, may have contributed inadvertently to a form of scientific ethnocentrism in the culture of inquiry in nursing as in other fields. The result has been a narrow view of science and knowledge and failure to (...) recognize the potential significance of Eastern philosophy in nursing knowledge development. Recently, intensive cultural exchanges between the East and the West have contributed to Western scientists becoming aware of the limits of Western linear thinking and concomitant efforts to explore the mysteries of Eastern philosophy. In this article, we explore Buddhism as one example of such philosophies that have great potential to enrich nursing as it continues to strive for definition and identity. (shrink)

Whenever the name Edmund Husserl appears in the context of nursing research, what correctly comes to mind is the phenomenological approach to qualitative methodology. Husserl is not only considered the founder of phenomenology, but his broad concept development also contributed to the demise of positivism and inspired fruitful approaches to the social sciences. In this spirit of inspiration, it must be expressed that Husserl's theory of wholes and parts, and particularly his differentiation of parts into ‘pieces’ and ‘moments’, is very (...) helpful in guiding the selection of research methods across the board in nursing science. The purpose of this paper is to highlight a frame of reference for nursing researchers to use in examining the essential nature of that which is being studied. This frame of reference is the Husserlian philosophy of ‘pieces’ and ‘moments’ in relation to the whole. ‘Pieces’ are independent parts of the whole that are subject to isolability in study, whereas ‘moments’ are nonindependent parts, which cannot be detached, presented, or studied apart from the whole. The intent is to propose this frame of reference as a philosophical base from which nursing researchers may better select among paradigms and methodological approaches in regard to the essential nature (‘pieces’ or ‘moments’) of that which they are researching. (shrink)

With questions raised as to whether or not nursing knowledge should be developed from extant conceptual/theoretical models or from practice-based environments, this paper utilizes Kuhn's disciplinary matrix and Laudan's model of consensus formation to explore the changing nature of the discipline's structural matrix. Kuhn's notion that a discipline's structural matrix includes symbolic generalizations, models and exemplars, and Laudan's view that a maturing discipline embraces factual, methodological, and axiological (goals and aims) knowledge, and that context and discourse are also involved in (...) advancing a discipline is described as a means for reconciling the source of nursing knowledge. This paper posits that shared axiological goals connect both theorists and practitioners, and resolve potential conflicts as to viable sources of nursing knowledge. Through shared goals that include humanization, meaning, quality of life, caring, consciousness, transcendence, and presence, which bridge both theoretical and practice approaches, nursing's charge to contribute to the good of society is fulfilled. (shrink)

The dissociation between the domains of knowledge continues to perpetuate the fragmentation of people’s health and healing experiences. Of particular significance are the polarities that have been created between the objective, subjective and spiritual dimensions of knowledge and human experience. This paper offers a consideration of how faith might serve as a pragmatic avenue towards assuaging the polarities between knowledges and enhancing nurses’ ability to attend to the complex and mulitdimensional nature of health and healing processes.

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. (shrink)

In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus (...) revisit the potential of Husserl’s notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl’s interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices. (shrink)

This paper attempts to philosophically articulate empirical evidence on the positive effects of illness within the wider context of a discussion of the positive aspects of vulnerability. The conventional understanding holds that to be vulnerable is to be open to harms and wrongs; it is to be fragile, defenseless, and of compromised autonomy. In this paper, we challenge the assumption that vulnerability consists of nothing but powerlessness and dependence on others. This paper attempts to: (1) outline the theoretical conceptualisation of (...) the positive aspects of coping with illness, while simultaneously showing how these findings provide empirical support for some classical philosophical ideas; (2) influence a change in the manners in which the ill are usually perceived (as weak, dependent, robbed of a good life) and (3) point to the importance of modernising the prevalent biomedical conception of illness with the subjective dimension of health. Biomedical understanding of illness focuses on the vulnerable experience of the sufferer, suggesting the importance of philosophical additions. (shrink)

This paper is a review of the experiences gained whilst working with the ‘expertise in practice project’. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice‐based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people (...) who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners’ concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient‐participants’ role as a sophisticated evaluator of health‐care. As a result, we present a case for transformational qualitative research. Such research is values‐driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its ‘ends’ (i.e. research products) but also, intentionally, through its ‘means’ (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self‐reflection) to examine and critique their personal values. (shrink)

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real‐life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from (...) the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. (shrink)

While health promotion is widely acknowledged as a practice field where multidisciplinary teamwork is important, within nursing's discipline‐specific literature, a strong argument can be discerned regarding the profession's belief that it has a clear and unique role to play in that field. Yet rarely is this unique role, how it arises, and specifically how its effects are to be demarcated, attended to within the discipline‐specific literature. Two philosophical perspectives on science are presented and we demonstrate the extent to which these (...) two perspectives influence nursing scholarship, including nursing practice within the field of health promotion. We then go on to argue that, for nurses to sustain their claim to a unique and important contribution within health promotion, clear articulation of the philosophical premises underpinning practice methodologies is warranted. Specifically we argue the importance of such clarity within the context of an analysis of the discourse of multidisciplinary practice as a strategy for avoiding confronting the ways in which bio‐medical authority has already significantly demarcated how health promotion practice can proceed. (shrink)

Immer mehr Menschen verbringen ihren Lebensabend in Einrichtungen der Altenpflege. Zusätzlich zur Sorge um physische, psychische und soziale Belange gilt es, deren spirituelle Bedürfnisse zu berücksichtigen. Ziel dieser Arbeit war es, die spirituellen Bedürfnisse von alten Menschen in Langzeitpflegeeinrichtungen zu erfassen. Gleichzeitig wurde untersucht, welche spirituellen Bedürfnisse Pflegende bei den ihnen anvertrauten Bewohner/-innen wahrnehmen. Dabei wurden Übereinstimmungen bzw. Unterschiede identifiziert. Daten aus 28 Einzelinterviews mit Bewohnerinnen und Bewohnern und 9 Fokusgruppeninterviews mit Mitarbeitenden wurden mittels Qualitativer Inhaltsanalyse ausgewertet und unter die (...) Kernkategorien „Sinn“, „Verbundenheit“, „Transzendenz“ kategorisiert. Die Kategorien beider Befragtengruppen wurden einem Vergleich unterzogen. Trotz zahlreicher Übereinstimmungen in den Aussagen beider Gruppen bleiben Defizite in der Wahrnehmung von Pflegenden. Aus den Ergebnissen der Arbeit werden Schlussfolgerungen für die Einbeziehung der spirituellen Dimension der alten Menschen in die pflegerische Arbeit im Seniorenheim gezogen und Empfehlungen ausgesprochen. (shrink)

Narrative inquiry in a nursing practicum One approach to creating research‐based nursing education is to think and write narratively about the daily life of a BScN program student and her teacher in diverse settings and over time. Gail, as a nurse‐teacher, and Faith, as a nursing student and now Public Health Nurse, reconstruct their teaching–learning experiences in an integrated practicum in maternal–child health services as a narrative inquiry. After presenting this reconstruction of experience at a conference on maternal scholarship, further (...) inquiry into their experiences shows how narrative inquiry matters to construction of nursing praxis and to life‐long learning as a nurse. Teaching–learning relationships are seen as a template for a student's connections to people experiencing nursing care and to other clinicians. Construction of stories to live by that take into account becoming a nurse, constructing knowledge and enacting caring–healing nursing practices is illuminated through narrative inquiry. (shrink)

Using touch as a medium for exploring the ways in which it is constructed by nurses, the body is here characterized by a plethora of competing and co‐existing terms: disobedient, obedient, mirroring, stigmatized, sinful, post‐mortem, sanitized, angelic, desexualized, dangerous, dominant, dominating, deceitful, submissive, disciplined, postmodern and communicative. We have tried to be provocative by juxtaposing contradictory messages and evoking conflicting emotions, and we hope that the reader will not assume that we believe everything we write, or that everything may be (...) taken only at face value. There are as many messages and meanings in the paper as each reader thinks there are. (shrink)

Paradigm debates have been featured in the nursing literature for over four decades. There are at least two opposing paradigms specific to nursing that have remained central in these debates. Advocates of the unitary perspective (or simultaneity paradigm) consider their theories to be more philosophically advanced and contemporary alternatives when compared to the older more traditional ideas characteristic of models they describe as originating from the totality paradigm. In the context of these debates, I focus on some theoretical positions embedded (...) in the unitary perspective, noting their limitations with respect to integrating the individual and social mandates of nursing; nurses are responsible not only for individual health‐related needs, but also for the health of the collective. I explore two hypotheses that may explain the powers of endurance of the unitary perspective. Paley, who outlines the origins of nurses' ‘slave morality’, inspires the first hypothesis. The second hypothesis speaks to the location of nursing knowledge development in the context of liberal ideology. In this work, I outline key conceptualizations of the unitary perspective in order to clearly illustrate the limitations of the unitary perspective for nurses' social mandate. Then, I explore how slave morality and liberal ideological assumptions might both work to sustain the unitary perspective. A paradigm for nursing must have utility in addressing both the health‐related needs of individuals, and for addressing the health of the collective. To this end, I advance suggestions in three areas: first, to transform nurses' slave morality to more honest and noble aspirations; second, to examine liberal ideological premises; and third, to end paradigm debate by resituating elements of the unitary perspective to the level of mid‐range theory, where it could be most effective for research and practice with specific populations. (shrink)