Nursing philosophy

Since the 1980s, increasing numbers of hospitals in the United States have formed internal ethics committees to help doctors and other health care professionals deal with complicated ethical questions, especially those regarding the end of a life. But it is only in recent years that German hospitals have followed suit. In "Conflicts of Care", Helen Kohlen offers the first comprehensive look at the origin and function of these committees in German hospitals. Using a mix of archival research, participant observation, and interviews, Kohlen explores the debates that surrounded their formation and the functions they have taken on since their creation.

This book explores nursing and complexity science, and investigates how they relate in research, education, and practice. The book examines the best methods for using complex systems, and the contributing authors are experts drawn from nursing, sociology, informatics, and mathematics. Each is actively involved in applying complexity science to diverse populations in various settings (especially, in terms of nursing, chronic care, health care organizations, and community health networks). Each chapter includes a response written by a nursing scholar, administrator, or practitioner, focusing on chapter concepts relevant to the complex systems seen in nursing. The book includes models that relate how these concepts can be used in practice, management, education, and research-from micro to macro scales. The first of its kind, this book demonstrates the potential of complex systems perspectives to understand and improve nursing and health care research, education, and practice.

Personal integrity is often seen as a core value for delivering ethical healthcare. This paper will explore what this might mean and particularly what place integrity has in a multi-professional healthcare system. Two opposing arguments can be made: the first is that the multi-professional nature of modern healthcare means that personal integrity is at best a futile luxury and at worst, an obstacle to delivering affordable high-quality care to large populations. The converse is that without personal integrity healthcare loses its humanity and becomes mere biological and social engineering. Part of the analysis rests on whether integrity is primarily a personally held moral framework or whether it is a social concept. Chester Calhoun's analysis, in which she identifies the integrated-self, personal identity, and (morally) clean-hands as three pictures of integrity, is used as the basis for suggesting that integrity is a rich and complex social virtue through which the individual ...

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto.

Abstract  Anthony Giddens’ theory of structuration is a theory of social action, which claims that society should be understood in terms of action and structure; a duality rather than two separate entities. This paper introduces some of the central characteristics of structuration theory, presenting a conceptual framework that helps to explore how people produce the systems and structures that shape their practice. By understanding how people produce and reproduce structures, then there is the potential for changing them. Criticisms that have been raised about the theory are introduced, followed by examples of how the theory might be useful to nursing research. Structuration theory can be employed to explore how nurses produce, reproduce, and transform nursing practice through social interaction across time and space.

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems.

Science seems to develop by inducing new knowledge from observation. However, it is hard to find a rational justification for induction. Popper offers one attempt to resolve this problem. Nursing theorists have tended to ignore or reject Popper, often on the false belief that he is a logical positivist (and hence hostile to qualitative research). Logical positivism claims that meaningful sentences containing any empirical content should ultimately be reducible to simple, observation statements. Popper refutes positivism by showing that there are no such simple statements. He is not a positivist. For Popper, the scientist begins with problems and puts forward trial solutions. These are subjected to rigorous testing aimed at falsifying them. A new theoretical position is then reached in which the scientist knows either that the trial solutions are false or that they have not yet been falsified. Science is characterized by the fact that it tests its ideas through attempted falsification. Non-science tests its ideas through attempted refutation. Nursing theory is a mixture of science and non-science. Popper's method requires rigorous testing of theory in both realms. As such, some nursing theory should be discarded. Popper's view faces at least two important criticisms. One is that a scientist can always reject an apparent falsification by instead altering some auxiliary hypothesis (e.g. denying the accuracy of the falsifying observation). Popper can deal with this argument by saying that defence of a theory in this way will eventually break down if the theory is false. The second criticism is that Popper's method does ultimately draw upon induction. This criticism is true, but his method can be usefully adapted. An adapted from of Popper's philosophy of science provides a good basis for nursing theory.

According to our previous research, the use of glory holes in public venues such as saunas and bathhouses is very popular. The popularity of glory holes is due in part to the anonymous sex that these architectural elements allow. This poststructuralist theoretical reflection seeks to understand the specific nature of anonymous public sex amongst bathhouse patrons, focusing on the links between desire–architecture–place–sexual practises. Drawing on interviews with glory hole users gathered during an ethnographic research project in bathhouses, this essay goes beyond traditional public health discourse to offer an original perspective on anonymous public sex. Utilising the philosophy of Deleuze and Guattari’s concepts of assemblages and machines, we re-theorise glory hole sex – what we call ‘faceless sex’ – and re-think the ways that desire is imbricated with our understanding of architecture, place, and public. Finally, we reflect upon the particular ethical challenges that are posed by these particular sexual practises, and ask whether a poststructuralist ethic might be possible.

Abstract In this paper, the theory and practice of therapeutic touch (TT) is scrutinized from a number of perspectives. Firstly, the alleged close relationship between TT and Martha Rogers’ Science of Unitary Human Beings is evaluated. Secondly, the employment of the language of modern physics in Rogers’ theory and TT is critically examined. The authors then review the research literature on TT's efficacy, completing their critique by discussing the ethical issues involved in the practice of TT. As each of the perspectives considered reveals some concerns, the paper concludes that TT is a questionable intervention, underpinned by a very weak theoretical, clinical and research base.

What Ivan Illich regarded in his Medical Nemesis as the "expropriation of health" takes place on the surfaces and in the spaces of the screens all around us, including our cell phones but also the patient monitors, tablets and iPads that intervene between nurse and patient. To explore what Illich called the "age of the show," this essay uses film examples, like Creed and the controversial documentary #Vaxxed, and the television series Nurse Jackie. Rocky's cancer in his last film (submitting to chemo to 'fight' cancer) highlights what Illich along with Petr Skrabanek called the "expropriation of death." In contrast to what Illich denotes as 'Umsonstigkeit' - not Gnade, grace, gift given undeservedly, i.e., gratuitously - medical science tends to be tempted by what Illich terms scientistic 'black magic', taking over (expropriating) the life and the death of the patient in increasingly technological ways, a point underscored in the ...

Understanding, shared meaning, and mutual trust lie at the heart of the therapeutic nurse–patient relationship. This article introduces the concept of clinical intimacy by applying the interpersonal process model of intimacy to the nurse–patient relationship. The distinction between complementary and reciprocal behaviours, and between intimate interactions and intimate relationships, addresses background concerns about the appropriateness of intimacy in nursing relationships. The mutual construction of meaning in the interactive process between nurses and patients is seen to lie at the heart of clinical intimacy as a hermeneutic enterprise. Intimacy is distinguished from empathy based on intentionality and the status and location of meaning. Reasons for continued investigation into clinical intimacy as an explanatory model for nursing as a hermeneutic practice are presented.

In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complex...

Abstract  This paper puts forward the argument that there are various, competing, and antithetical evidence-based practice (EBP) definitions and acknowledges that the different EBP definitions are based on different epistemological perspectives. However, this is not enough to understand the way in which nurse professionals choose between the various EBP formations and consequently facilitate them in choosing the most appropriate for their needs. Therefore, the current article goes beyond and behind the various EBP epistemologies to identify how individuals choose an epistemology, which consequently will assist our understanding as to how an individual chooses a specific EBP formation. Individuals choose an epistemology on the mere belief that the specific epistemology offers the ideals or ideas of best explaining or interpreting daily reality. These ideals or ideas are termed by science, history, and politics as ideology. Similarly, individual practitioners choose or should choose between the different EBP formations based on their own personal ideology. Consequently, this article proceeds to analyse the various ideologies behind different EBP definitions as to conclude that there are two broad ideologies that inform the various EBP formations, namely the ideology of truth and the ideology of individual emancipation. These two ideologies are analysed and their connections to the various EBP formations are depicted. Eventually, the article concludes that the in-depth, critical, and intentional analysis by individual nurses of their own ideology will allow them to choose the EBP formation that is most appropriate and fitting for them, and their specific situation. Hence, the conscious analysis of individual ideology becomes the criterion for choosing between competing EBP formations and allows for best evidence to be implemented in practice. Therefore, the best way to teach EBP courses is by facilitating students to analyse their own ideology.