While nursing practice embodies certain observable and sometimes habitual actions, much inheres in these actions that is not immediately discernible. Taking on Lyotard's exegesis of the unpresentable, I undertake an analysis of the unpresentable as it occurs in nursing practices. The unpresentable is a place of alterity often excluded from dominant discourses. Yet this very alterity is what practising nurses face day after day. Drawing from two nursing situations, one from a hermeneutic phenomenological study and the other from the literature, (...) I elucidate the unpresentable from a nursing point of view. Evoking Lyotard as well as selected philosophers from the continental philosophical tradition, I also question whether nursing in its present discourse is capable of responding to the unpresentable in nursing situations. Through the philosophical stance of presentation and representation, I delineate the urgent need to bring the otherness of the unpresentable into our nursing discourse. Nurses in practice confront a wide array of human differences and diversities and come to the realization that no framework alone can ever really have primacy over the multiform presentations of human suffering that so strikingly evoke alterity. (shrink)

Philosophers who specialize in bioethics face a distinctive set of challenges in our work: to bring the theoretical insights of philosophical work and methodology to practical dilemmas affecting a diverse group of stakeholders every day. This article describes some of the key contributions that philosophy can make to the field of bioethics. It also identifies some of the pitfalls that can undermine the value of a philosophical approach when used to analyze questions arising in the real world. Recognition of the (...) importance of individual context, practical implications, and social considerations can help successfully bridge the gap between theory and practice. Using this wide-angle lens to view bioethical problems can enable philosophers working in our field to offer insights that are both rigorous and relevant. (shrink)

The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse–patient interactions, thereby decreasing (...) the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse–patient relationships, as signalled by the American Nurses Association’s first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs. (shrink)

This paper offers an alternative to deontological and utilitarian approaches to making ethical decisions and taking good actions by organisational leaders. It argues that the relational and context-dependent nature of leadership necessitates reference to an ethical approach which explicitly takes these aspects into account. Such an approach is offered in the re-conceptualisation of ethical action on the part of leaders as a process of "coming into right relation" vis-à-vis those affected by their decisions and actions. Heidegger's notion of "dwelling" is (...) explored as a means of "coming into right relation". Three aspects of dwelling: "staying with", "comportment" and "active engagement" are described and ways in which they might be practically enacted by leaders are suggested. The paper concludes by reflecting on the ways adopting a "dwelling" approach to resolving ethical issues implies a re-conceptualisation of leadership itself. (shrink)

This paper provides an analysis of nursing as a knowledgeable discipline. We examined ways in which knowledge operates in the practice of home care nursing and explored how knowledge might be fruitfully understood within the ambiguous spaces and competing temporalities characterizing contemporary healthcare services. Two popular metaphors of knowledge in nursing practice were identified and critically examined; evidence-based practice and the nurse as an intuitive worker. Pointing to faults in these conceptualizations, we suggest a different way of conceptualizing the relationship (...) between knowledge and practice, namely practice as being activated by contextualized knowledge. This conceptualization is captured in an understanding of the intelligent creation of context by the nurse for nursing practice to be ethical and effective. (shrink)

Review of Martin Heidegger, An Introduction to Metaphysics.

Diverse beliefs about the nature and essence of scientific truth are pervasive in the nursing literature. Most recently, rejection of a more traditional and objective truth has resulted in a shift toward an emphasis on the acceptance of multiple and subjective truths. Some nursing scholars have discarded the idea that objective truth exists at all, but instead have argued that subjective truth is the only knowable truth and therefore the one that ought to govern nursing's disciplinary inquiry. Yet, there has (...) been relatively little critical debate or dialogue about the implications of adopting subjective and multiple truths as a maxim to govern the discipline. In this paper we examine what it might mean to adopt subjective forms of truth as the only knowable truths for nursing, and to accept the possibility of multiple co-existing realities. We understand the implications of such a philosophical stance for the epistemological basis of a practice science to be considerable, therefore we consider what it might mean for a practice-based discipline such as nursing to remain ambiguous on the question of truth, and examine the implications of failing to achieve consensus on what constitutes a truth claim. On the basis of this examination, we urge a cautious approach to the extremes of either position and argue for a more thoughtful and rigorous dialogue about ‘truth’ and knowledge in nursing practice, education, and research. (shrink)