Philosophies transcend time as well as disciplines. Ever since nursing has been practiced as a science it has informed various philosophical paradigms, which most evidently undergirds observation, diagnosis, intervention and evaluation of diverse issues which plague both humans and the profession exclusively. Obviously, the foundation underlying this development of professional and personal approaches to implementation within the practice are ‘ways of knowing.’ Basically, ways of knowing determine the right nurse for the correct client, the appropriate procedure to be administered at the right time and overall correctness in dispensation of nursing care. (Rozella, 2001). Precisely, aesthetics, socio-political influence; ethical implications; personal sentiments along with empirical evidences ( Polifroni, 2010) are the five keys to unlocking ways of knowing in relation to philosophy of nursing in the twenty first century.
Personal Philosophy of Nursing: Ways of knowing
My personal philosophy of nursing encompasses a wide range of theoretical perspectives espoused in assumptions advanced through ‘ways of knowing’ or alternatively called ‘patterns of knowing’ being interchangeable verbalized based on preferences. Even though this discussion relates mainly towards my feelings about professional practices, from the tone of my exposition it is clear that ways or patterns of knowing form the foundation of my thinking.
Consequently, it is the author’s desire through the following pages of this document to project a philosophical paradigm based on the importance of knowledge in guiding action throughout nursing practice. It would be observed that from the inception nursing was performed from a holistic approach. (Nightingale declaration) Knowledge was, however, limited to predict outcomes and non scientific presumptions regarding both diagnosis and prognoses infiltrated the discipline.
Therefore, it is my belief that as twenty-first century professionals much more is required of practitioners. Successful research findings have expanded the scope of practice. While more studies are being conducted to improve delivery of care we ought to utilize the resources available at this very moment through strategies outlined in ways/patterns of knowing.
Empathetically, as more investigations into scientific developments within the discipline are undertaken the’ theory of integral nursing’ emerged being posited by Dossey (2008). This evolved in direct appreciation of a holistic approach towards nursing as a science. Dossey (2008) advanced four assumptions in articulating this theory. First as a way of knowing she perceived humans containing energy fields, which are interconnected in a manner that everyone affects the other. Secondly, it projects an integrated world view of human experiences as part of personal subjective; behavioral objective; culturally inter-subjective and inter-objective systems or structures. (Dossey, 20008)
Thirdly it is further assumed that healing is not acquired, but rather inherent as a natural phenomenon, which could ultimately lead to curing. (Dossey, 20008). Nonetheless, it is not synonymous with it. Fourthly, integral health is a concept denoting wholeness or a feeling of completeness. It is related to expansion of human consciousness within spirituality. (Barnum, 2003). Distinctively, it is through these parameter that you can scrutinize my personal philosophy of nursing.
Aesthetics is a demonstrated pattern of knowing. Sung Eun Yang (2010) referring to Carper (1978) advanced that it is ‘the art of nursing.’ This appeals to my integrity as a nurse since my belief is that indeed nursing is the execution of art besides a vocation. Hence, when Aesthetics is burrowed from the fine arts discipline to describe nursing practice it brings alacrity to my heart.
However, in relation to nursing, aesthetics brings peculiarity and distinction to the science because it is an innovation in itself. Yang (2010) further emphasizes that it involves individual experience exclusive to the practitioner’s acquisition of knowledge from previous practical applications. Importantly, while the nurse carries herself/himself into the innovation it is not from a perception of mere intuition, but rather definite patterns of execution enhanced by consistent patient client interactions. (EffKen, 2001)
In substantiating the assumption Yang references Edwards (2010) to emphasize that it is no magic utilizing a sixth sense dimension. (Edwards, 2001) Precisely, this is acquired from years of applying appropriate principles as intervention techniques and practices. (Edwards, 2001)
Within these concepts lies my conviction that knowledge forms an integral aspect of nursing process. My belief is that nurses are efficient practitioners if they can adequately apply theories to real world situations thereby helping to secure more favorable outcomes. Eventually, improvement in the quality of life for clients under their care can be enforced.
Many times one wonders how relevant are socio- political implications in determining ways or patterns of knowing. The truth is that within these major factors, lie a gamut of issues that suggest who gets care, quality of it , boundaries to be observed , levels of delivery and cultural beliefs that affect outcomes.
Andrist (2010) and others quoting Jacobs-Kramer and Chinn (2010) posited that socio-political ways of knowing can be understood at two levels. First at the level of nurse- client interaction within defined clinical settings and secondly through nursing as science so determined by social structure. Health care in many developed country is a business. It involves insurance coverage in obtaining quality of care, referrals to specialists and cost of care. (Andrist, Nicholas & Wolf, 2010)
Therefore, nursing practice as a science has its boundaries within this context. For example, it is important for the nurse to know that a celebrity or president of a nation does not find him/herself in the same health care institution as the person residing in a ghetto or slums of any country.
Besides, there may be exclusive categories of nurses attending to that level of clients’ socio-political orientation within the particular health care system. While my philosophy of nursing edges on non -discriminatory practices in the science this differentiation becomes inevitable. The nurse so often is caught as a target of dispensing discriminatory categorizations due to social status.
There is no doubt that ethical knowledge has broadened the scope of nursing practices initiating public protection from non –professional innovations within the discipline. My personal philosophy supports transparency by upholding ethical standards legislated within the profession. Yang (2010) emphasizes, utilizing theories advanced by Carper (1978) that ethics is closely related to one’s moral conscience. (Yang 2010).
Importantly, it determines that which is appropriate and what is not. It engages both client nurse relationships as well as interactions among levels of health care providers operating within the same institution or closely related ones. Nurse practice acts legislated by governmental authorities across the world present guidelines for acceptable and unacceptable behavior within the science. (Nursing and Midwifery Council, 2008).
For me ethics do not embrace maintaining patient’s rights while preserving their integrity during any intervention, but gaining cooperation when conscious and obtaining consent of surrogates if unconscious. Yang (2010) mentioned ethics citing drug administration when a patient remains in pain after doses of analgesia have been administered. He calls this unethical nursing practice. ( Yang, 2010)
In my opinion here is where cooperation and consent are vital as it relates to quality of care. Moral dilemmas occur in such cases when pain management from a pharmacological standpoint is outside the jurisdiction of clinical nursing practice. How does the nurse respond? Every discipline has ethical codes, norms and values. ( Nursing and Midwifery Council, 2008).
Nursing is no different and knowledge pertaining to ethics is relevant for proper practice.
Hence, it is my personal philosophy that the necessity for licensure procedures; academic requirements; accreditation of training institutions and collaboration among health care professionals in the provision of evidenced based patient care interventions, will always exist. (Hannigan, 2005).
Personal knowing is fundamental to understanding the meaning of health across cultures and within distinct professional practice. It is upon this platform that nurses can develop efficiency in the science. (Thompson & Dowding, 2002). Theorists have emphasized that it impinges greatly on one’s self perception and awareness. (Johns, 2004).
In a very intimate sense it is asking who I am as a nurse? What do I bring to this profession? What is my self concept as it pertains to my practice? How do I judge my clients? Are evaluations based on my world view? Are they objective enough to be empathetic? These are the assessment measurements that determine whether a nurse is experienced, efficient, proficient, and skillful or merely an apology in the profession.
My conviction regarding this aspect of personal knowing is that as nurse I must be innovative; exemplary and equipped with skills to portray my personal knowledge. This information must provide the foundation for me to function effectively in the position I was designated to execute.
What would any science be without empirical knowing? Arguments have been overtime that nursing cannot empirically be considered a science. Then, what it is? Stalwarts have counteracted these claims to say that the primary pattern or way of knowing in nursing philosophy, internationally, is ‘empirical, factual, descriptive…’ (Andrist, et, al. 2010). Conclusively, the desire is to eventually develop abstract theoretical assumptions. (Andrist, et.al)
Why is this so? Andrist, Nicholos and Wolf (2010) have together advanced prepositions to indicate that from evidence based nursing research theories emerge. These theories create a reservoir of empirical knowing. Hence, nursing/nursing practice is a science based on empirical knowing. ( Andrist, et.al, 2010).
This explanation is intriguing as my personal philosophy of nursing is exposed. However, suggestions for improvements have been posited since empirically, there are limitations regarding the methodology whereby knowing occurs. Theorists confront the issue of ‘relativist ontological’ (Andrist et.al, 2010) approaches in retrieving knowledge to imply that it ought to be revised. From observations the present methodology attempts to tell stories through interpretive description rather generalization.
Explicitly, in the foregoing pages of this document my personal philosophy of nursing was carefully outlined. It is my belief that the five patterns/ ways of knowing must inform practice. All five are equally important for advancement in the disciple. History shows how philosophies have converged, but a common thread of knowing has been transcending competing philosophies. (Benner, 2001).
Even though Florence Nightingale’s model of nursing could be considered obsolete by twenty-first century nursing science it led the path to obtaining ways/ patterns of knowing. Precisely, during nursing infancy through ‘the lady with the lamp,’ (Nightingale declaration) understanding of the whole being and its implications of total recovery has been the burning issue of all propelling inquiry and research. (Nightingale declaration)
As a twenty-first century nurse I embrace a philosophy, which undoubtedly extends across disciplines in designing most appropriate outcomes for my clients. The time for speculations is over. Empirical, aesthetics, ethics, sociopolitical and personal knowing are now available as deliberate beliefs systems to be adopted in execution of roles and responsibilities within the discipline.
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