Personal Philosophy of Nursing
The word philosophy is derived from the Greek and Latin word philosophic, the love of wisdom. It is defined as the “critical examination of the grounds for fundamental beliefs and an analysis of the basic concepts employed in the expression of such beliefs.” (Encyclopaedia Britannica, 2002) Nursing philosophy then, would be the examination of the fundamental beliefs about nursing practice. That it were so simple! It is the time consuming, soul-searching act of composing one’s personal thoughts, feelings, and knowledge, then committing them to practice. It is the summary of beliefs regarding what nursing is, what it aspires to be, and how those aspirations can be realized. It is a guide to learning and practice, and a measure of that practice. Rew (Kikuchi, 1994) asserts that nursing philosophy is a dynamic vision of who we are, “what and how we know; and of what we do within the discipline” (p.
20).
A nursing philosophy explores several areas including the definitions of person and what it means to be human. It looks at the nature of nursing, the nurse-person relationship, and the focus of nursing. The focus and goals of the philosophy are stated, as well as the values that guide the practice of nursing. Finally, how this philosophical perspective influences research and scholarship.
On the Nature of Being Human
Person is defined as a single human being, a family, a community, a nation, a race, a culture, or all mankind.
The person is a complex synthesis of their past experience and their expectations of the future. The person operates within a self defined, fluidly dynamic physiologic, psychological, sociocultural, developmental, and spiritual environment. A fluidly dynamic environment is one which is not static, but flows in and around the person affecting every aspect of life, including the physical, psychological, social, cultural, developmental and if one chooses, the spiritual aspects of life. The person interacts with this environment, and by their actions, changes it yet again. It is self-defined by the choices one makes to change the environment, for good or ill.
For example, one may live in an environment that is not considered optimal and have little choice in what goes on there, nevertheless, one can still make choices that will affect and influence the environment and their well being. The person always has a choice. The person can always choose what environment they will create. Within this environment, the person attempts to maintain their best possible balance.
Nature, Focus and Goal of Nursing
Nursing is a unique combination of art and science. Kleinman (2001) asserts, and I whole-heartedly concur, that a nurse is a person who has intentionally chosen to become a nurse and has made a commitment to help other human beings.
Nurses practice the art and science of nursing by addressing caring interventions toward the whole person as they interact with and attempt to balance their environment. Nursing promotes health and assists the person with adaptation to their environment. Nursing is person centered caring, in a culturally sensitive environment, helping the person move toward their best possible balance. This is accomplished by nursing interventions, education, referrals to outside agencies, or whatever is needed. I t does not include doing all for the person, but allows the person to do for oneself, with assistance as needed.
A nurse-person relationship is initiated when a person recognizes a present or possible imbalance in their environment. After assessing their own resources and recognizing a need for assistance, the person may ask for assistance. This request may be subtle (vague questions) or overt (pale, cold, and diaphoretic) and may be couched in cultural meaning or symbolism. When the request is recognized, both the nurse and the person then assess the nature of the imbalance, what can be done about it, and how much assistance is actually wanted.
This requires a sharing of knowledge, respect for the person’s culture, and a respect for their continued independence and self-direction. Once the care is mutually agreed upon, it is the nurse’s responsibility to provide that care or to find someone who can (multidisciplinary). The focus and goal of nursing should be to assist the person in achieving and maintaining the best balance possible, given the environment.
Guiding Values for Practice and Practitioner
Values represent the concepts, ideals, behaviors, social principles, and major themes that give meaning to the profession. They are the product of our philosophy and our philosophy is the product of our values. Ethics are the manifestation of what we say we value and they influence our actions.
Important values are competence in practice, self-awareness, respect for person and human dignity, confidentiality and privacy, never causing harm, and last but certainly not least, is caring. Care as defined by Merriam-Webster’s is “painstaking or watchful attention; a person or thing that is an object of attention, anxiety, or solicitude” (1977, p. 168). Caring is the soul of nursing. Care and caring are part of life and are essential to growth and self-actualization.
Caring transcends cultures and society like no other action or emotion. It is a quality that is uniquely transcultural, more so even than love. Love is give and take. Caring is giving only, asking nothing in return
Nursing Research and Scholarship
Numerous theories of knowledge development exist in nursing and each must be considered on its own merit and relevance to the area being studied. Carper’s (1978) theory of the Fundamental Patterns of Knowing in Nursing identifies four : empirics, ethics, personal, and aesthetics.
She believes that these patterns correspond to theories of nursing and can be used as modes of nursing inquiry. This seems a reasonable assertion, but I would go one step further and propose that we view these ways of knowing as a pyramid, with empirics as the broad base the others stand on, next would be ethics, above that aesthetics, and at the pinnacle personal knowing (see figure 1). Similar to Maslow’s Hierarchy of Needs (Pearson, 1999), the basic necessities of life must be taken care of first. It would follow that the most basic ways of knowing must first be employed.
Thus having a sound and broad knowledge base, one can progress toward more complicated and less structured ways of knowing. Nursing must have a strong, grounded base to build on. As with any building, if the basic groundwork is not strong then the entire structure is weak. This strong grounding is provided by sound and thoughtful research, which is factual and verifiable.
The search for this grounding is never ending; one problem solved brings another problem to light. As a profession evolves, this process is repeated over and over.
Different methods are tried, kept and / or discarded. A balanced search for nursing knowledge should include an understanding of the diverse nature of the profession.
According to Newman, Sime, and Corcoran-Perry (1991) a number of concepts have been identified as being central to nursing revolving around health and caring. I believe that in the future nursing scholarship goals should include health promotion, quality of life and death, quality of care, as well as cultural and ethnic considerations as they apply to health care. Additionally, Fawcett, Watson, Neuman, Walker, and Fitzpatrick (2001) believe, and I agree, that inquiry into standardization of practice with theory guided evidence based care is a necessary goal.
Conclusion
This philosophy addresses the person, who may be one or many, and how a person in the nurse- person relationship, operating within a self-defined, complex environment attempts to maintain their best possible balance between the elements of this environment. This philosophy presents ideas regarding what nursing should and could be, how the nurse should relate with the person, as well as the focus and goal of nursing in assisting the person to choose, achieve and maintain the best balance possible. Caring as the soul of nursing is endorsed, as well as additional values and ethics that should guide the practice of nursing. In addition, concludes with a view of research and scholarship within this philosophical perspective.
This philosophy may be used in any environment and with any person.
It is simply stated and easily understood. As such, practitioners of any skill level could use it in their practice. It is my hope that this philosophy will be the basis for caring practice in the years to come. Additionally, I envision that nursing will work toward a unified presentation of our practice. Humans are very complex and caring for humans is a complex process, but nursing cannot appear so complex as to be impractical. The nursing we practice is a reflection of our core values.
We will be known not by our words but by our actions.
Figure 1. Pyramid representation of Carper’s Fundamental Patterns of Knowing
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