Personal Nursing Philosophy: Holistic Patient-Centered Care

Philosophy, Theory, and Science in Nursing

Those unfamiliar with nursing — beyond occasional contact with a nurse in an emergency room or while receiving a vaccination — may be surprised to learn that there is any theory or philosophy to the profession at all. Even to the experienced nurse, this view is understandable, for nursing is fundamentally practical. Nurses are defined in large measure as the people who do not panic in any situation and who know exactly what to do in any contingency. Such a practical, if expansive, basis of knowledge does not necessarily seem to have any theoretical underpinning.

Indeed, it is probably true that many nurses, like many other professionals, move through their day without consciously realizing that they are drawing on a unified — or at least mostly unified — set of precepts and values that underlie and support their behavior and the choices they make. There is nothing wrong with this, of course. The very reason one has an integrated philosophy informing daily behavior is that in the moment-to-moment rush of getting everything done, one cannot continually be consulting a complex series of mental paradigms.

However, this does not mean that one should never stop to consider the ethos that informs one's professional identity. Not only does such reflection help ensure that one does not stray from one's core values — something that is all too easy in the chaos and frustrations of daily life — but it also helps ensure that one's ethical code evolves as one gains increased experience and knowledge in one's field.

Moreover, to suggest that a unified philosophy is irrelevant to a profession so dependent on practical skills is to suggest that an airline mechanic testing the rudder of a plane does so without any understanding of aeronautical engineering. What nurses do seems so straightforward precisely because it is founded in an overall theory of how healthcare should be administered. Among the most important theories that has informed nursing since at least the nineteenth century is the model of empiricism — the philosophy that one's actions should be based on fact, especially fact verified through experimentation. This is the basis of the scientific method from its inception.

Empirical Bases of Nursing

Given that nursing is in no small part a scientific field, it must at all times be informed by empiricism: the biology of the human body is based on tolerances that are known and that must be respected. However, the knowledge that arises in the laboratory — no matter how valid or secure — is not the only basis for nursing. One of the great challenges for all medical professionals, including nurses, is how to blend knowledge that arises in the context of basic science with knowledge that arises within the context of the practice of medicine (Meleis, 2006, p. 81).

There is, in fact, a long-running tension between the ways in which knowledge is developed and deployed in the medical field. Very few doctors and nurses are also research scientists; the reverse is also true. This is not surprising: given the time required both to train for these different fields and to practice them, very few individuals could possibly do both. But the fact that scientists who develop new medicines, new devices, and new protocols are divorced from the complexities of actual medical practice can prove to be highly problematic.

Faced with scientific, empirical facts and advice that do not seem to hold up to the immense — and even seemingly immeasurable — complexity of patient-to-patient variability in medical practice, there can be a temptation to discard what is useful from basic science along with the oversimplifications of experimental conditions (Chinn & Kramer, 2010). This is highly unfortunate, given that without the rigorous protocols of science, medicine would be little more than prayer. In other words, there is more than one way to learn about the world, and the medical professional must acknowledge this and not be too wedded to a single approach.

Constructivist and Interpretivist Models

Medicine is often described as a blend of science and art, and this is true. But even this understates the complexity of medical — including nursing — practice and theory, for science is only one of the rational ways by which humans acquire knowledge. The knowledge derived not through experimental means but through real-life experience under conditions of genuine complexity, as opposed to the artificially simplified conditions of a laboratory, must be honored as well (Chinn & Kramer, 2010, pp. 217–219).

Nursing theory and epistemology — the ways in which knowledge is created and transmitted within the profession — must be multi-layered and multi-valent. The ways in which nurses learn from their education, wedded to their own experience, must be blended together in ways that honor both the black-and-white nature of many important scientific findings and the ways in which experimental results must constantly be adapted to fit the rapidly changing demands of working with a patient.

This is an essentially constructivist perspective, a theoretical model that posits that knowledge must come from as many valid sources as possible and that it is the responsibility — as well as the privilege — of each individual to construct a personal compendium of the possible ways of learning, knowing, and interpreting from all of the different means of acquiring knowledge and skills. The fact that nurses must draw from different sources and determine for themselves what relative weight to give to different types of information from different sources places significant intellectual demands on the profession.

This is a heavy responsibility for each nurse. It is intellectually and cognitively easier, as well as ethically less problematic, to accept a set of facts or a professional philosophy wholesale rather than having to piece together a personal philosophy. However, this latter approach can be far more personally satisfying (Reed & Shearer, 2007, pp. 148–149). It can also be sufficiently flexible to carry a nurse through all of the complicated situations that he or she will encounter.

References

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. London: Saunders.

Tomey, A. M. & Alligood, M. R. (2005). Nursing theorists and their work. Boston: Mosby.