The ethical ‘eye’ of nursing, that is, the particular moral vision and values inherent in nursing work, is constrained by the preoccupations and practices of the superordinate biomedical structure in which nursing as a practice discipline is embedded. The intimate, situated knowledge of particular persons who construct and attach meaning to their health experience in the presence of and with the active participation of the nurse, is the knowledge that provides the evidence for nurses’ ethical decision making. It is largely (...) invisible to all but other nurses. Two nurse researchers, Joan Liaschenko of the University of Minnesota and Patricia Rodney of the University of Victoria, have investigated the ethical concerns of practising nurses and noted in their separate enquiries the invisible nature of critical aspects of nursing work. Noting the similarities in their respective observations, and with the feminist ethics of Margaret Urban Walker as a theoretical framework, this article examines the concept of ‘invisibility’ as it relates to nursing work and nursing ethics. (shrink)

Ten nurses at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The main theme in the narratives was being close to and moved by the suffering of patients and relatives. The nurses' responsibility for patients and relatives was expressed as a commitment to act, and they needed to ask themselves (...) whether their responsibility had been fulfilled, that nothing had been left undone, overlooked or neglected, before they could leave the unit. When there was confirmation by the patients, relatives, colleagues and themselves that the needs of patients and relatives had been attended to in a morally and professionally satisfying manner, this increased the nurses' confidence and satisfaction in their work, and their strength to live with the burden of being in ethically difficult situations. (shrink)

Doctoral programmes in nursing are charged with developing the next generation of nurse scholars, scientists, and healthcare leaders. The American Association of Colleges of Nursing (AACN) endorses the inclusion of philosophy of science content in research‐focused doctoral programmes. Because a philosophy course circumscribed to the natural or social sciences does not address the broad forms of knowledge that are relevant to nursing practice, we have developed and co‐taught a course on the philosophy of knowledge that introduces students to competing claims (...) regarding the nature of knowledge, truth, and rationality. In addressing broad themes related to science and knowledge of the body, health and illness, and ethics, the course equips students to tread the rough and shifting ground of nursing scholarship and practice. Providing doctoral students with this philosophical footing is intended to give future scholars, researchers, and healthcare leaders the intellectual skills to critically reflect on knowledge claims, to challenge the hegemony of science, and to recognize the disciplinary forms of knowledge that are left out or trivialized. Our pedagogical approach to knowledge development does not denigrate scientific knowledge, but elevates forms of inquiry and notions of clinical knowledge that are too often marginalized in doctoral education and the academy in general. (shrink)

For nursing, the idea of bearing witness is of utmost importance. Nurses are present with persons who experience changes in their health and quality of life and who live intense and profound moments of struggling, questioning, and finding meaning. Nurses are also with persons from moment to moment as their lives unfold, and when joy, serenity, contentment, vulnerability, sadness, fear, and suffering are experienced. In this paper, it is proposed that bearing witness is a moral way of engaging in the (...) nurse–person relationship. Based on Levinas’s ethics of the face, it is claimed that bearing witness is enacting one’s moral responsibility, which arises from the encounter with the other. Drawing on Parse’s human becoming theory, ways of witnessing and bearing witness are defined and discussed. It is suggested that bearing witness is a human‐to‐human way of being‐relating, a mode of human coexistence. Bearing witness is being present and attentive to the truth of another’s experiences. Moreover, in this paper, the ways nurses enact their moral agency and bear witness to others placed in their care, or turn away, are explored. Nurses’ moral agency is located in the constrained moral space of contemporary health care. Hence, the creation of a moral space, which allows nurses to enact their moral responsibility of bearing witness to other persons’ experiences of health and quality of life, is called for. In doing so, it is suggested that the act of bearing witness needs a specific nursing knowledge base and a recognition that being present and being with another is a valuable nursing practice that is utterly meaningful for persons who are living through difficult times. (shrink)

The events of the Holocaust of European Jews (and others) by the Nazi state between 1939 and 1945 deserve to be remembered and studied by the nursing profession. By approaching literary texts written by Holocaust ‘survivors’ from an interpersonal dimension, a reading of such works can develop an ‘ethic of responsibility’. By focusing on such themes as rationality, duty, witness and the virtues, potential lessons for nurses working with people in a variety of settings can be drawn. Implications for the (...) teaching of nursing ethics are made in the areas of the virtues, relationships, professional ethics and the moral community of nursing. (shrink)

In this paper I explore the possibilities of nursing as safeguarding through a phenomenological description of a small sculpture by the German artist Käthe Kollwitz. My discussion will be grounded in Heidegger's understanding of technicity as a pervasive systematizing and aggressive challenging‐out. The method is grounded in Merleau‐Ponty's and Heidegger's contention that strong artworks are truth‐disclosing and show up our precognitive contact with the world. Bringing nursing concerns to an encounter with single strong artworks can help us cultivate a more (...) receptive openness to our patients. (shrink)

This paper explores the relationship between temporal continuity in nursing and temporal features of sickness. It is based on phenomenological and hermeneutical philosophy, empirical studies of sickness time, and the nursing theories of Nightingale, of Benner and of Benner and Wrubel. In the first part, temporal continuity is defined as distinct from interpersonal continuity. Tensions between temporal continuity and discontinuity are discussed in the contexts of care management, of conceptualisations of disease and of time itself. Temporal limitations to the methodological (...) concept of situation are discussed. The main part of this paper explores nurses' possibilities to relate to their patients' time, and how temporal features of sickness may warrant temporal continuity of nursing. Three temporal characteristics of sickness are discussed: the immediacy of patients' suffering, the basic continuity of life through sickness and health care, and the indeterminism and precariousness of sickness. The timing of nursing acts is discussed. The paper explores how sickness is both part of the continuity of life, and threatens this continuity. It concludes that this tension is implicitly recognised in the temporal continuity of nursing, which allows for discontinuous and continuous aspects of sickness time. Nurses accordingly perceive the sick person's time at several levels of temporality, and distinguish highly complex temporal processes in their patients' trajectory. Temporal continuity provides the time, flexibility, and closeness for nurses to perceive and act into time dimensions of individual sickness. The paper shows that temporal continuity of nursing is grounded in temporal characteristics of severe sickness. It suggests that temporal continuity is an important theoretical concept in nursing. (shrink)