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There are clear philosophical connections between the core ideas of hermeneutics and those of historicism, because each posits a potentially radical degree of relativism. Rodgers & Knafl (2005) explore this, arguing not for a return to any radical empiricism but rather to acknowledge that while knowledge and certainly medical praxis is socially constructed (and constructed along lines of socially sanctioned power hierarchies), there are fundamental empirical elements to nursing that cannot be trivialized.
Moreover, Rodgers & Knafl (2005, p. 118) argue that such a trend towards a radical sort of relativism (or, perhaps more accurately, a fully realized postmodernism) is not in keeping with the philosophical tenets and requirements of the hermeneutic writers that nurses have embraced: While knowledge is certainly socially constructed, the key to a hermeneutic reading is a focus on the social nature of the way in which knowledge is created and transmitted.
It is important to note that this is in no way an argument for a privileging of solipsism. Hermeneutics is not at any level an attempt to validate the idea that we can each make up our own reality. Indeed, to suggest anything like this is to do a great disservice to this philosophy (Rodgers & Knafl, 2005, p. 120).
A hermeneutic approach requires an individual to understand how the ideas current in a particular historical moment create complicated connections between new and old knowledge and practice. This requires nurses (in this case) to understand how they as part of an entire medical team are being influenced by past notions of how they should work.
An historical perspective
This very brief overview of some of the most important philosophical theories that have informed and continue to inform nursing practice demonstrates how much the profession has changed over the last several generations of nursing. At its inception as a profession, that is, during the Civil War, nursing relied on rationalism and empiricism as much as possible. This should hardly be a surprise for two distinct reasons. The first of these was that early leaders in the movement to professionalize nursing (for of course, nursing as a practice is as old as the human family) were women who wanted their work to be taken seriously.
In the very male world of medicine in which they were working, the first nurses had little choice but to borrow the masculine language and ideas of science as a way to validate to the rest of the world the work that they were doing. nor, it seems likely, would they have been otherwise inclined to reach outside of the scientific perspective as a way to understand and explain their own work. Nursing as a profession arose (and this is of course not entirely coincidental) during the decades in which the Industrial Revolution was bringing the practical applications of science more and more to the forefront of daily life.
The shift to a more constructivist, less empiricist view of nursing has come about since the middle of the last century, and especially since the 1970s. This was due in some significant part to the fact that as more and more nurses were educated in formal university nursing programs (rather than receiving training more on the job), they became more and more influenced by the dialogue that was going on in other areas of academia. Just as the rest of society was caught up in radical changes during the 1960s, the university too was changing, admitting theories such as historicism (all the way through the most radical forms of postmodernism) that required people in different fields to recognize that truth is often far more relative than is comfortable to acknowledge (Tomey & Alligood, 2005).
The last decade and a half have seen something of a pendulum shift back to a more empirically informed philosophy of nursing. The pendulum will never swing back as far as it once was, for there was a certain (dangerous) naivete to the original empirical writings in all of the medical fields. (Indeed, there remains in many fields of medicine a certain disingenuousness about the extent to which medical knowledge is True). However, medicine -- unlike literary criticism, for example -- can never be radically relativist. There are facts in medicine that can never be negotiated or reinterpreted.
This is the current state of theory in nursing: Some things are simply true. And the vital corollary of this is that one can never know what those things are without a serious effort at self-knowledge and without a similarly serious attempt at understanding the social constructs and constraints of the worlds in which nurses work.
Personal philosophy: A holistic benefits the patient
My own personal approach as a nurse working with adult cardiac patients is a holistic one. For me, this holistic approach has several elements. The first is that I view each patient as a complete person, as someone with a life that began long before he or she entered the hospital and that will -- with the staff's skilled care as well as the always needed element of luck -- continue long after the patient has been discharged. A holistic approach means that one never considers the patient to be simply a single organ system or set of symptoms
The second branch of the holistic tree of nursing for me is that a nurse must always treat the patient as a member of a family rather than as an isolated individual. Family members are key elements of any patient's recovery from cardiac disease. This is true both in a good sense and a bad sense: Supportive family members will help a patient heal much faster and more completely. Family members who are not supportive can sabotage the patient's healing in a number of ways. Both possibilities must be understood by a nurse, who must then try to find ways to maximize supportiveness while limiting any attempt on the part of the patient's families to do conscious or unconscious harm.
Finally, as suggested by my analysis of the different philosophies of nursing above, a holistic approach to me signifies that I will draw from any of the philosophical or analytical theories that I am familiar with to help my patient. For example, I will stress to my patients that it is imperative that they follow as closely as possible the drug regimens that their physicians establish for them. In the area of cardiac medication, I believe that empiricism is the best possible approach.
However, in other areas of treatment, recuperation, and healing, I will adopt a constructivist approach when I believe that will be the most helpful for my patient. A good deal of healing is subjective, and in no small measure what a patient understands to be progress and healing is up to him or her to determine. Doctors can be far too committed to only objective measures of healing, which can be an alienating and even fundamentally depressing experience for patients. In such cases, part of my work as a nurse is to help the patient come to an understanding of healing that is empowering and entirely personal.
Chinn, P. & Kramer, M. (2010). Integrated theory & knowledge development in nursing. Boston: Mosby.
Meleis, a.I. (2006). Theoretical nursing. . New York: Lippincott Williams & Wilkins.
Reed, P. & Shearer, N. (2007). Perspectives on nursing theory. New York: Lippincott Williams & Wilkins.
Rodgers, B. & Knafl, K. (2005). Nursing: Foundations, techniques, and applications.…[continue]
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