Nursing philosophy and theory

Nursing

Most scholars are in agreement that art is a component of nursing. However, there is a vast difference between Appleton's (1993) account of art as a unitary experience and Carper's (1978) reductionist approach to conceptualizing nursing art.

In your own words, define the terms "unitary" and "reductionist" as they relate to premise of this article. (2) Based on your professional nursing experience, which description of art is dominant in your worldview of nursing? (3) Give one example from professional nursing practice to illustrate your view.

(1) The term "unitary" denotes a community set of values and concepts centered on personal care and concern for others, as well as on a constant goal of community wellness. Unitary nursing, therefore, can be thought of as a set of concepts related to patient care, concern, and overall intuition of being that is shared by both the nursing community as well as the patient community. This set of concepts includes a high regard for other individuals, whether in a shared profession or as patients, and a sense of the connectedness within which these individuals exist. Rather than caring for patients as mere medical inhabitants, the unitary perspective teaches to care for the integrity and honor of those patients in a way that is universal to the human condition. Additionally, the unitary perspective teaches to commit oneself as a nurse to the transformation of patients in health of all aspects, including medical, mental, and emotional, and to use these transformations to liberate all patients from their conditions. By using the term "unitary," this set of values denotes a strong tendency towards a wholeness approach to nursing that encompasses all aspects of life, including intuition, knowledge, and compassion for the plight of others, and a sincere desire to participate in their overall healing. To some, this approach involves the unseen aspects of life including emotion, spiritual, and, essentially, the care of the human soul in addition to the care of the human body.

A. (1) "Reductionism" on the other hand, denotes an approach to nursing that is based on logic, knowledge, and theoretical perspective as separate entities. In reductionism, the care of patients is reduced to knowledge alone, whether such knowledge is obtained through empirical, ethical, personal, or visual knowledge. Such an approach reduces a patient to an observable set of patterns and interrelated aspects that are easily identified. Rather than relying on intuition, integrity, and honor, the reductionist approach focuses more on the logical, rational, and scientific care of patients. While this approach does not reduce the emotional component of nursing, it does emphasize a reasonable approach to all care aspects.

A. (2) In my view of the world of nursing, the unitary concept fits best with both the expected role of professional nurses and with the overall need of patients. Rather than relying merely on empirical knowledge of charts and medical science, the art of nursing involves the ability to intuitively know the needs of other human beings, regardless of condition. Upholding the integrity, honor, and rights of patients in addition to caring for their medical needs is vital to the art of nursing. Without such values as a clear concern for a patient as a member of the health community, patients are reduced to mere forms, able to be examined, but not understood. It is in understanding each patient as a member of a connected group of individuals that nursing art is truly developed and improved.

A. (3) The unitary approach is clearly applicable in professional nursing practice. Take, for example, the case of a 26-year-old male HIV-positive patient admitted for repeated respiratory infections. A nurse practicing the unitary approach may intuitively know the patient suffers not only from his medical condition, but also from low-self-respect as a result of his condition. During a conversation with the patient, the nurse is told of high stress levels from hiding the illness from family and friends. The nurses in charge of his care realize regaining control over his life is a primary priority for the man, so carry out a pattern manifestation appraisal to determine the link between the patient and his environment. Based on the results of the appraisal, and on one-on-one conversations with the patient, the nurses develop health promoting activities that include stress reducing back massage, mind relaxing yoga, and emotional therapeutic touch sessions. Through intuition, care, and concern for the physical, emotional, spiritual, and mental state of the patient, the nurses, without a quantitative evaluation, are able to assist the patient with honor, integrity, and a complete desire to allow the patient to transform his life to improve his overall condition (Chen, 2000).

B. Do you believe that the art and science components of nursing are mutually exclusive, opposing belief systems? Or do you ascribe to the belief that nursing is an interwoven tapestry of art and science forming a single belief system. Clearly state your opinion and provide a nursing example.

B. In my opinion, nursing is an interwoven tapestry of art and science forming a single belief system. As Wainwright (1999) stated, art and science are similar, in that they both contain a body of knowledge that provide sets of principles, values, and regulations that direct behavior. Whereas science looks at empirical information and observable knowledge to form those principles, art examines the humanity, values, experiences, and human essence that are unique to each person, but that represent the totality of human existence. While these two different aspects of nursing appear at first to be contrary, they are in reality complimentary to one another in terms of patient care.

By examining the empirical information available for any given patient, a nurse is able to ascertain specific scientific information regarding the individual. In gathering such information, the nurse can delve into his or her knowledge to discover ways to interpret, examine, and act on that information. However, at the same time, a nurse must examine the human aspects of the patient, including their emotional, mental, and spiritual state to discover the totality of that patient's experience. The nurse can then again delve into his or her knowledge base to attempt an understanding of the patient's true experience. By doing so, he or she can act on the information is such a way as to treat the entire individual, without resorting to a reductionist view that assists only the physical portion of the patient.

In this way, science and art work together to provide a full picture of a patient's experience in an effort to convey understanding in a way the patient will understand. Further, by combining art and science, the nurse is able to successfully use a combination of logic and intuition to develop actions that assist the patient in all areas of healing, including those of the physical, mental, emotional, and spiritual states. In doing so, nurses become holistic in their practice, and successful in their care. As Rogers (1990), stated about nursing as a combination of art and science, "[nursing] is the study of unitary, irreducible, indivisible human and environmental fields, people and their world." (Rogers, 1999, pg. 6).

To illustrate how science and art can be used together to create a single belief system, and to properly care for individuals, take a case study from Nagai-Jacobson and Burkhardt (1996). In this case study, a 57-year-old woman enters the clinic with severe headaches and gastrointestinal distress for approximately three weeks. Using a scientific, logical approach, doctors and nurses initially run a battery of tests, and complete the physical exam. The results, however, show no obvious cause for illness. Sensing possible personal issues, the primary care nurse begins to gently question the patient about her home life. The nurse discovers the woman has recently lost her brother-in-law, with whom she shared a close relationship. During the recanting of the story, the nurse shows compassion, empathy, and concern, and encourages the woman to speak freely of her experience. As the woman discusses her feelings, she discovers she has not dealt with her grief effectively. As a result, the primary nurse suggests several methods of assistance, including suggestions of writing a letter to the deceased explaining her feelings, seeking counseling for her grief, yoga, meditation, and massage therapy. When the woman returns in three weeks for a follow-up, her symptoms have disappeared, and she expresses intense gratitude to the nursing staff for their ideas and compassion (Nagai-Jacobson and Burkhardt, 1996).

In this case study, it is clear the combination of science and art play important, complimentary roles in nursing. Logically, when a patient presents specific symptoms, it is important to investigate those symptoms using empirical evidence. At the same time, however, a nurse's intuition and experience can suggest other causes for more general symptom patterns, and the combination of body and soul, or science and art, can be combined to provide a treatment plan that remedies both the physical symptoms, as well as the underlying emotional causes of those symptoms.

C. Parse (1997) proposes a way of enhancing knowledge of unitary creations called "concept inventing." (1) What does the phrase "concept inventing" mean to you?

2) Does the process of concept inventing add clarity to a unique lived experience that aides in individualizing patient care? - or - Does the process of concept inventing add unnecessary jargon to the profession of nursing which creates barriers in collaboration with other disciplines? (3) State your stance on this issue and create a logical argument to defend your thoughts.

C. (1). "Concept inventing" can be thought of as a way to analyze situations in such a way as to contemplate their meaning to create understanding. Using both the aspects of science, including logic, rationality, and empirical analysis, and art, including intuition, emotion, integrity, honor, and compassion, nurses can process information in such a way as to create a complete conceptual picture of both the abstract aspects and concrete facts of a situation. In doing so, nurses can create a basic definition of concepts that capture both the diversity and the personality of each patient, while simultaneously incorporating the experiences of others to create a universal concept.

C. (2). The process of concept inventing adds clarity to unique experiences that assist in individualizing patient care.

(3). First, the process of concept inventing is constantly moving, in that each concept is able to later be adjusted based on each unique experience. The concepts created are not meant to be stable, but instead are meant to guide one to a definition that captures the diversity of human life, and human experience. The general idea is to guide nurses to a structural, personal definition to advance their own knowledge. In attempting to understand each human being, and how that human being's experiences, thoughts, feelings, and emotions can be incorporated into the universal experience of human kind, a nurse can further their own knowledge of the human condition.

Even the process of creating a concept adds to the ability to view each patient as a unique and individual person in the community of human existence. Each new case requires a nurse to dwell on learned information from the patient, to strongly listen to intuition to provide a starting point for the concept, to listen carefully to the patient for possible clues to their experiences, and to appreciate each experience as unique. At the same time, a nurse is forced to take this information and use it to further their definitions, or concepts, that apply to the universal community. Through this encompassing thought process, a nurse is able to better understand, comprehend, evaluate, and care for each patient. The individualized nature of the concept invention process forces the nurse to view each life experience of each patient as individualized. As a result, the process of concept invention adds clarity to unique experiences that assist in individualizing patient care, as well as adds a layer of self-understanding to the lives of nurses that allows them to care for patients in a more personal manner. Process invention, in other words, exists as a part of the unitary concept of nursing, in that the process drives to find universal experiences on a personal, individualized plane.

D. In some journals, you will see "call-outs" placed strategically throughout the article to grasp the reader's attention or to highlight key points contained within the article. These callouts are brief, usually less than twenty words, and may be a whole or partial sentence. If you had to develop three "call-outs" to emphasize three main points of this article, what would they be?