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Assignment:  Write a 10 page paper on nursing philosophy.  Expound how it relates to the theorist of your choice, the nursing metaparadigm, and implications for nursing practice.

Could anything be more painful?  Or boring?  Or seemingly unimportant and irrelevant?  Really….is this going to be of value doing CPR on your patient who just coded from a drug overdose?  How do these nurse academicians think up this stuff, anyway?  That’s what I used to think, too.
Set those thoughts aside.  Negativity is of no help to you now.  Nursing philosophy and theory IS important.  That’s why your professor created the assignment.  Don’t let the unfamiliarity of it scare you off.  I’ll help you with it.
Reality:  The paper is 25% of your grade.PLAIN TALK:  Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like. So philosophy affects both the beginning and end of nursing actions. It explains why you do the things you do, and why you do them in the way that you do them.

Let me help you tackle it.  These assignments are so often way too broad and extensive, mainly because professors often don’t appreciate the enormity of what they’re really asking.  The one thing that helps the most is to imagine how you would explain to a friend why you went into nursing, what “health” is, and what nursing should “look like”.  In this case, you’re explaining it to your professor.  Here’s how to do it:
1.  Break down the assignment into its basic elements:
     A.  Personal philosophy of nursingSee my prior blog post on this topic.
     B.  Metaparadigm:  Nurse, patient, environment, health.  Although this is taken as written as stone, you may, like I, not fully agree.  But accept it for now.  Changing metaparadigms is a lot of work.
     C.  Definition of nursing.  The most widely accepted definition is the American Nurses’ Association definition.
     D.  Theorist of choice.  This often depends on the type of patient you’re caring for.  No one theory works for every setting.  So state up front what kind of patient you are thinking of and that will direct your choice of theory.  Write in your paper that no one theory works for everything.  Justify why  you have chosen that particular theory for that particular kind of patient and that particular kind of nursing.  For example, a post-op orthopedic patient fits well with Orem’s self-care theory.  Care of the chronically ill/diabetic Hispanic patient is a nice fit for Leininger’s transcultural theory.  The newly divorced patient or newly widowed patient fits with Meleis’ transitions theory.
2.  Another element you need to think about is your philosophy of health.    Nobody ever talks about this.  You need to think about what is health?  It’s not necessarily the nursing metaparadigm.  Read through this blog to get more ideas.  Come to your own conclusions.  You need to state your beliefs about health.
3.  Once you’ve decided on the elements above, you need to figure out how these elements relate together.  The most common error is to try to say everything about every element.  That ends up a bloated, overwritten, blob.  Pick one small area of each element and link it logically to all the other elements.  For example, maybe you center it all on a hypothetical patient.  Maybe you will focus on the generalities of a quality of nursing, like caring and show what that looks like at each level.

What you are doing is building a pyramid.  The bottom layer is your philosophy.  The next layer is the nursing metaparadigm, then the theory, then nursing practice, then the particular patient where one-on-one nursing occurs.  Your job is to connect the dots from one layer to another.

Remember:  Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like.  So philosophy affects both the beginning and end of nursing actions.  It explains why you do the things you do, and why you do them in the way that you do them.

Good luck.  You’ll do fine.  Let me know how I can help.

Plain Talk:  Google’s search engine confirms it:  Philosophies of health don’t really exist.  And they should.  They must if nursing is going to advance in its philosophical work.  That’s the only way healthcare will advance past the current models.

The Details:
Nursing philosophy is hard because most of the time what is being referred to is not nursing philosophy, but health philosophy.  The professor assigns the nursing students the ever-elusive, most hated assignment:  “Write a 5-10 page paper on your nursing philosophy, undergird it with theory, and demonstrate how it is implemented in the four domains of nursing (nurse, patient, environment, health), and justify your reasons for your position.”  This is literally an impossible assignment.  Volumes have been written on these subjects.  It cannot be addressed in a short paper.  The single revelation here is that even professors don’t understand it.  I don’t fault them, though, because our discipline has not adequately pursued the development of philosophy.

I’ve realized over the last few years, though, that the main difficulty lies in the fact that we have not adequately stated a philosophy of health.  With all the various interpretations and dimensions of health discussed in nursing, psychology, medicine, and sociology, we are still missing something.  I think that “something” is found in our presuppositions…our fundamental beliefs and assumptions that guide our view and interpretation of the world. 

The quandaries of the nursing philosophy assignment is a clue to the fact that we don’t have it quite right.  Look at how nursing views “health”:  physical, emotional, spiritual, environmental.  It’s a modular idea.  We took the medical paradigm of the body’s mechanical functioning, glued on emotional and spiritual dimensions, and set it against a backdrop of environment.  When all systems are “go”, we want to call it “health” or “energy” or “being”.  Even integrative medicine that emphasizes nutrition, stress reduction, and exercise are generally based on a modular approach.

If nursing is going to make sense of nursing philosophy, it needs to consider philosophies of health.   The current philosophy of health as stated in the paragraph above is inadequate.  Before we can be prescriptive (make recommendations for people’s health) we must be proscriptive (describe what health is & is not).  Since health has come to mean more than the physical, and more along the lines of human flourishing, then we have to figure out what constitutes human flourishing.

Enough for now.

(Photo source:  Research Haven)

Plain Talk:  Thinking of health as mind-body-spirit, while useful, in its own right, leaves out the importance of meaning and purpose that we know we are made for.  We have to include this when we think of health.

The Details:
No nurse (at least in the western world) sees nursing as “just” caring for the sick, the babies, and the old people.  Heaven forbid.  Hopefully, we’ve come much farther than that.  But we have much farther to go, in my opinion.

If I asked you to tell me how nursing is different than medicine, you’d probably offer that medicine is disease-focused, and nursing is holistic, and by that you would mean that nursing considers the “whole” person.  You would describe to me that people are not just bodies, but also made of a unity of body, mind, and spirit.  Nurse scholars have offered similar concepts.  McEwen &Wills (2007) put it this way:  “Person refers to a being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his parts.” (p. 43).

We’ll come back to this.

Next, consider the objectives of the nursing profession:  care of the sick, care of the well, assisting self-care activities, helping people attain their human health potential.  McEwen &Wills (2007) continue:  “The purposes of nursing care include placing the client in the best condition for nature to restore health, promoting the adaptation of the individual, facilitating the development of an interaction between the nurse and the client in which jointly set goals are met, and promoting harmony between the individual and the environment.  Furthermore, nursing practice facilitates, supports, and assists individuals, families, communities, and societies to enhance, maintain, and recover health and to reduce and ameliorate the effects of illness.” (p. 43).

I hoped you picked up on the common bond between these well-accepted explanations of person and of the purpose of nursing.  The commonality is that of a systems framework.  When man is conceptualized as a system, then any nursing interventions will necessarily be systems-oriented, if nursing is to be at all congruent with their philosophical foundations.  But for reasons I’ll discuss below, I think this is a thoroughly short-sighted framework that has squelched the work of nursing, at least theoretically speaking. 

At the risk of sounding disrespectful, one can pretty easily substitute “dog” (especially a smart dog like mine) in the above definitions and have coherent statements.  I’m not saying nurse scholars through the ages think of humans as mere systems.  It’s obvious they don’t think that. I definitely appreciate the great difficulty that arises in finding adequate language to describe the nature of man.  That’s been the plague of philosophy for ages, after all.

But is there a more robust conceptualization of man and by extension, nursing, that will take us beyond this constrictive framework of “mind-body-spirit”?  I believe there is.  Indeed, nurse researchers have come close to it in their studies on hope. 

What I am proposing is a re-conceptualization of man within nursing philosophy that places the focus on vision, passion, and purpose of the individual.  This new paradigm more rightly aligns “health” with the true nature of man.  Health is not a repair schedule in which “systems” are fixed and fiddled.  Health, true health, is when people possess a passion for the purpose of enriching the lives of others and themselves by virtue of a higher vision for a meaningful life that reaches outside themselves to others in goodness.  This is the only explanation offered by say, a patient with terminal cancer, who is consumed not by cancer, but is consumed with life purpose.  This vision and passion I speak of is akin to hope but not the same as hope.  I think passion is much deeper than hope and I think it is more representative of how we would describe true health.  It is a passion fueled by virtue.

As nurses, if our calling is to direct patients towards true health, then our focus cannot solely be on a systems orientation.  The absence of physical (system) illness is not true health. The absence of mental (system) illness is not true health.  The absence of emotional (system) illness is not true health.  The absence of spiritual (system) distress is not true health.  A “working” systems paradigm cannot constitute true health, because we are not, fundamentally speaking, a set of systems. 

We must look far beyond the confines of systems paradigms.  Is it possible to instill a sense of vision, passion, and purpose in our patients?  Of course it is. The opportunities are immense.  This is a huge field ripe for some creative and scholarly research focused on optimizing the individual to live a life of importance, of service, of love.

Lack of purpose robs.  Lack of passion starves.  Lack of vision kills.  We were not made for ourselves only…such thinking is destructive to our souls and bodies.  Think how much “healthier” we would all be if we just had a megadose of vision, passion, and purpose to benefit others and truly impact our world.

The new metaparadigm for true health:
Perceive the vision.
Possess the passion.
Pursue the purpose.

 
See.
Feel.
Live.

Stay tuned.  More to come as we flesh this out little by little and see how it fits within the Perspectival Evidentialism model.  Let me know your thoughts.

McEwen, M. and Wills, E. M. (2007).  Theoretical Basis for Nursing. 2nd ed. (Philadelphia: Lippincott Williams & Wilkins.

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Every discipline has its philosophical foundation, and nursing is no different. Philosophy attempts to answer the questions of what nursing is, why it exists, and what ethics and values underpin these beliefs. Inherent in any nursing philosophy is how man is conceptualized. If you are new to nursing philosophy, this is where I would recommend you begin in identifying your own philosophy of nursing.

Nursing philosophy, like any other discipline-specific philosophy, is what directs and drives research and knowledge development to advance the discipline. Philosophy, then, articulates the core beliefs of a discipline and defines the boundaries of what we want to know about our discipline.

Your personal nursing philosophy is not your treatise on why you want to be a nurse. It is not a statement about what nurses do in context of health and illness. If that is where you’re at right now, you need to drop down a level, because what nursing “looks like” must be undergirded by why it should look like that (whatever “that” is). You are trying to explain to someone else why nursing exists. Go deeper than the superficiality of “nursing helps people maintain health” or “nurses alleviate suffering”. Incessantly ask yourself “why”. Get past the superficial.

Philosophy is formed from intuitions and beliefs about the way life should be and why you think it should be that way. You should consider the following questions when you write your personal nursing philosophy:

1. What is the purpose of man’s life? Why do you believe what you believe?

2. Why do people value health? How does health relate to man’s purpose?

3. How does illness interfere with our purpose in life? Or does it?

4. How do you define health? How is that related to your idea of man’s purpose in life?

5. What do you believe about the community of man? What are our social obligations to our fellow man? Why?

6. Is “health” a right? Or is it an ideal? Is medical care a right? Or is it an ideal?

7. By now you should have an idea about what ethical values you think should be held by nurses. Again, this is related to your concept of humanity and our purpose in life.

8. If you get stuck anywhere along the way, keep asking yourself “Why do I believe this?” and you’ll eventually get there, though it can be mind-boggling at times. You’ll find that your answers always revolve around values and morals and purpose. That’s why it’s important to know what you believe and why. Keep asking these questions of yourself.

By working through these questions you will arrive at how nursing fits into your philosophy of man, because your philosophy will reflect what you believe about yourself, and it should also lead you to why you chose nursing as a profession.

Philosophy can be intimidating, but it is just a fancy term for your beliefs and your justification of those beliefs. Good luck! Email me with your questions. I’d also love to read your philosophy! pamelafruechting@gmail.com

What is this image?

Your answer is dependent upon your knowledge base, your life experience, and on what you believe to be true.

The formation of any answer will first pass through these filters before you assert your most plausible explanation. Your presuppositions are these filters, these primal assumptions, through which you interpret life and assign meaning to it.

Presuppositions are deeply rooted in us, they vary from person to person, and undergo change as we travel through life. They underpin our values and ethics, and constitute the core foundation of all that we are and do; they are the fountain of what we believe ought to be and what ought not to be. They are so fundamental we often don’t recognize them, but they direct our thinking and doing every moment.

What did you decide? Abstract art? Computer bit-map? Microscopic cellular disease cluster? Electron microscope photo? Satellite photo? Enlarged pixels?

This image is a satellite photo of irrigation circles in southwest Kansas. Each white dot is a harvested circle, and each red dot an unharvested circle. Each circle is generally 1/2 mile diameter (4 per square mile = 1 section = 640 acres), though they can be up to a mile diameter.

How you answered was contingent on your presuppositions. Indeed, all of philosophy is grounded in presuppositions. For nursing philosophy to be useful, our presuppositions about human nature and the world must be accurate.

There exists a curious absence of presuppositional frameworks in nursing philosophy that I want to identify and wrestle with over the next several years. I am of the opinion that our best chance of a global definition of nursing lies in the secret room of presuppositions.

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