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Posts from the ‘Philosophy’ Category

Human Flourishing: A Nursing Ethic

Our current featured article in ANS is titled “An Innovative Professional Practice Model: Adaptation of Carper’s Patterns of Knowing, Patterns of Research, and Aristotle’s Intellectual Virtues.”  The author, nurse ethicist Barbara Bennett Jacobs, MPH, PhD, RN, translates an adaptation of Carper’s patterns of knowing into a nursing metalanguage of science, ethics, art, and advocacy.  Dr. Jacobs shared this commentary on her work that gave rise to this article:


Dr. Barbara Jacobs

The phrase “change is constant” is being used now by hospital administrators to partially explain the restructuring of departments and services that is often accompanied by acquisitions of smaller and/or regional hospitals into large corporations.  These changes in health care delivery systems are not limited to hospitals, as these corporations include, for example, agencies and services that provide home-care, out-patient services, emergency medical services and other community health care enterprises.  As the template changes, so does the status quo.  This ought to empower nurses to evaluate the status quo and suggest changes within the nursing profession for a number of reasons.  The one most obvious reason is, as Dr. Kagan opines in her guest editorial, – “to make things better.”  Better patient outcomes, better patient health, better prevention strategies, better human flourishing.

Without an underpinning in nursing knowledge, nurses will be ill-equipped to ask critical questions, to analyze the status quo, or through a process of praxis change those practices and structures that are unjust or inequitable in their practice environments.  The ethos of nursing is a strong one and ought to be visible, evident, and valued and unique from the institution’s ethos.  In order to accomplish this in the rapidly changing health care environments, imagination and innovation have the potential to make a difference.  Unfortunately, “change is not constant” in nursing education and practice to the degree it is in other realms of health care.   Take for example electronic charting – a wave of tsunami proportions.  As nurses now are more tethered to the i patient (a phrase coined by Dr. Abraham Verghese to describe the patient as data points) they are less available to move in the patient’s landscape with hopes of performing acts of aesthetic quality or to engage in such a way that is personal, intersubjective and meaningful to the patient.  Yet the technology prevails with support from some nurses, but others lament their loss of time to “be with” patients.  The question to ask is whether some innovation like electronic charting is in harmony with the voice of nursing, the ethos of nursing, and the philosophy of nursing or is it another institutional innovation that requires acquiescence and submission by the nursing population with minor input.

Thirty years ago Carper gave us an understanding of what nurses need to know to do what they need to do that is recognizable, valued, and defined as knowing that can be expressed as knowledge.  The professional practice model concept is fertile territory for planting these patterns of knowing along with other important concepts such as values, virtues, and research in such a way that the model enhances its applicability, adaptability, and usefulness to achieve the telos of nursing.  Professional practice models benefit the institution for sure but the real benefit, the real truth, the real reason to have them is to join in solidarity with those persons, families, and communities who call on nurses to answer the moral call to enhance their threatened human flourishing.

The model presented in this paper has been revised, revised, and revised again so as to reflect the thousands of patient narratives I have been blessed to experience.  The two patients in the paper are real, both having a profound impact on my current role as a nurse ethicist.  Both patients were not only medically complex requiring empiric knowing, both where vulnerable to threats to their self-determination requiring ethical knowing, both ached for meaningful personal encounters with their nurses requiring aesthetic knowing, and both changed (as did the nurses who cared for them) requiring personal knowing as a result of the covenantal relationship.  This model may not appeal to every nurse but the hope is that it will generate dialogue, reflection, and controversy.

Please consider entering in to dialogue here!  Download your copy of this article now while it is featured, and come back here to share your thoughts, challenges and questions!

Intellectual Curiosity

This week we introduce a new “Editor’s Pick” article titled  “Intellectual Curiosity: A Principle-Based Concept Analysis” by Bedelia Russell,  MSN, RN, CPNP-PC, CNE.  She has shared the background about her work with us, providing insight into the influences on her thinking including her daughter’s drawing!

If someone had told me when I began doctoral work I would not only contribute to ANS but also participate in the ANS blog, I would have questioned their sanity. I am so honored to be among all these other respected contributors. I began my doctoral work in 2010 following nine years of work as a fulltime faculty… I was the last Master’s prepared nurse to be tenured in our system so tenure was not a variable in my return to graduate school. Why then consider the daunting task of PhD work? When I reflect back, I guess I am guilty of the very subject of my article… intellectual curiosity. Around me… everyone was going back to school… newer faculty with eyes on tenure had made the commitment and I was continuing on in my role as a well-respected educator. But the pressure was there… internally, some external… to join in, and admittedly, I was curious. Could I do the work? Bedelia RussellHow would I balance family? Would I finish? How would I continue to do my job… my job … it was then it hit me… my pull towards PhD work, my motivation, was my job… I had hit a plateau in course redesign and I was asking questions and approaching nursing education with questions that no one around me could answer. It occurred to me that maybe doctoral study would help with those questions and provide new insights into my practice of nursing education.

Intellectual curiosity is something I have for many years evaluated baccalaureate students on… they either demonstrated it or they did not… and I knew what that looked like. So when my first concepts class in my doctoral program required a concept analysis, my cohort talked me into analysis of intellectual curiosity. I remember us all trying to decide on our concept and throwing out ideas to each other. When intellectual curiosity was suggested, it was followed by my peers adding, that should “be easy” and there should be “plenty of information out there.” I have both thanked them and cursed them since those days of convincing me but would not for one day regret the path that seemingly simple decision has led me down.

My work so far has revealed two things. The first is concept analysis that can provide context and understanding of the existing state of the concept is important to advance the science of our discipline. It is in part why I utilized a principle-based concept analysis method. I do not believe it is enough to simply breakdown a concept into its elements… we need to take that concept and look at it from multiple perspectives… multiple disciplines… and then see how our discipline can utilize it. The second revelation is that while I knew what intellectual curiosity looked like… albeit, merely from my perspective… I was unaware of the possible influencing variables and potential consequences for intellectual curiosity.

I am now intrigued with the role it seems motivation has in relation to curiosity. I am left to wonder what our role should be as nurse educators in influencing and modeling the concept of intellectual curiosity and can we perpetuate curiosity once is has occurred.

An important lesson from our first semester philosophy class was to determine our philosophy of science. It was an arduous discovery of finding out I aligned with interpretive inquiry, specifically with Heidegger’s assertions on phenomenology. This view was cemented in a drawing my youngest daughter made at that time, included here.

drawingWhen I asked my four year old daughter where her eyes, nose, and mouth were, her response was “Mommy, I am looking at the clouds…. You are looking at the back of my head.”  This picture is now a bit faded but still hangs on my wall beside my desk. It serves as a reminder on the importance of context, history, and multiple perspectives… something important in examination of the concept of intellectual curiosity in my work ahead. Going forward, my dissertation will look at intellectual curiosity from the perspectives of educators who teach in online learning environments. I welcome your comments on my current work and am both humbled and appreciative of this opportunity for dialogue.

You can download a copy of this article now, while it is featured on the ANS web site!  Then, leave your comments here to discuss your thoughts with the author!

Philosophic inquiry for nursing: a crucial connection

Because nursing is a very “practical” endeavor, the crucial underpinnings of philosophy are sometimes difficult to recognize.  But in this article the authors, Pamela J. Grace, PhD, RN, FAAN and Donna J. Perry, PhD, RN, explain why this is such a critical connection.  Their article titled “Philosophical Inquiry and the Goals of Nursing: A Critical Approach for Disciplinary Knowledge Development and Action” is currently featured on the ANS  web site.  Dr. Grace and Dr. Perry provided this interesting background to their work:

From Pamela Grace: The idea for this paper had been germinating a long time and went through several iterations. It benefited from the critique and suggestions of many colleagues, doctoral students and the ANS reviewers but we are sure that there is much more that can be said and we look forward to an ongoing dialogue.

A very early version of the paper was presented as part of a 4-paper symposium sponsored by International Philosophy of Nursing Society (IPONS) members and accepted for presentation at the Royal College of Nursing (RCN) 2010 Research Conference. IPONS is a forum for philosophical dialog and has among its aims: “to promote and establish philosophy of nursing, and health care in general, as a credible and important field of philosophical and critical inquiry” and that was the intent of the symposium to highlight the role and importance of philosophical thought for disciplinary purposes.

The shape of this version emerged as a result of co-teaching a doctoral seminar at Boston College with Donna Perry in the Spring of 2012. The course was focused on understanding philosophical and socio-political influences on health policy and ways in which nursing research can be use to inform and shape health policies. I used a much rougher draft of the paper as one of the assigned readings. Donna’s insightful and helpful suggestions on the manuscript, ideas about the hierarchical structure, and addition of Lonergan’s thoughts really helped refine the paper in a way that we believe makes it broadly useful to the profession.

The original and more personal reason for the paper is that, over my many years as a practicing nurse both in critical care settings and later in primary care as an ANP, I struggled with the healthcare environment – how it often and sometimes in subtle ways undermines good practice or fails to meet the needs of individuals and their communities. This struggle led me to doctoral studies in philosophy. I was hoping to learn ways of addressing practice problems. In this environment I was free and indeed encouraged to question everything. The skills and perspective gained I took with me into nursing academia only to discover that this sort of probing inquiry, that is not afraid to question how various projects and different levels of curricula meet nursing goals, seems to be losing ground as a valued a mode of knowledge development.

FYI the International Philosophy of Nursing Society  (IPONS) annual conference is in the US this year (Atlanta) Sept 7-9th.

From Donna Perry: My interest in philosophy stemmed from my undergraduate education at Saint Anselm College. The curriculum there was centered in an innovative and engaging humanities foundation which integrated scholars and scholarship from multiple disciplines. I took several extra courses in philosophy and found that it provided a helpful lens for all my future studies. When I started doctoral work at Boston College I purposefully sought out the philosophy department where I was introduced to the work of Bernard Lonergan, S.J. who had taught at BC. His cognitional philosophy provides a rich account of interior human consciousness. My own research focuses on transformative decision making around social issues that impact health. I found that Lonergan’s philosophy provided a deep and encompassing viewpoint from which to address issues of concern to humanity and to nursing.

When Pam extended an invitation to work with her on this manuscript I eagerly accepted. Not only was the topic of interest but I felt that it was critically important to address the importance of philosophical inquiry in nursing. It is important to note that this manuscript continued to evolve after submission. Reviewers who generously shared their time and thoughtful comments were instrumental to this process. The reviewers’ comments on the initial manuscript raised questions about the broad scope we had ascribed to philosophical inquiry. As all good questions do, these caused me to think critically about our paper. The different activities we had described were all important elements of philosophical inquiry. But clearly we needed to develop a way to differentiate and organize these different components. The process of bringing some clarification to this range of philosophical activities gave me the insight into developing a taxonomy for philosophical inquiry. Our hope is that this taxonomy might be helpful for scholarly development in the profession as we seek to address the many contemporary challenges to health and further the human good.

If you have not already, visit the ANS web site and download your copy of this very interesting article at no charge!

Making time for dialogue

In contemporary academic cultures, time for dialogue has become almost extinct. Productivity has succumbed to the tendency to seek measurable outcomes of concrete products, which in turn neglects the vital conceptual, theoretic and philosophic underpinnings that make reliable and valid concrete outcomes possible.  When dialogue is neglected, scholars are deprived of the important processes of challenge and critique, processes that serve to refine and develop ideas in the context of community values.  The authors of the current Editor’s Pick article share their process of scholarly dialogue that  extends the debate on the topic of militarization of nursing. The article, titled “Making Time for Reflexive Dialogue in Philosophical Group Discussion: Extending the Debate on the Militarization of Nursing” is authored by  Rusla Anne Springer, PhD; Arlene Kent-Wilkinson, PhD; Carol Ewashen, PhD; and Ruth Ali, MN. In the article they call for more dialogue among nurse scholars as an avenue to examine nuances in language and discourse that sustain inequity, injustice, and cultural practices that

Rusla Anne Springer

Rusla Anne Springer

diminish human health and well-being.  The authors provide this background about their process:

The formation of the Inter-University Philosophical Discussion Group, from which this collaborative paper arose, stemmed from a shared desire on the part of Springer and Ewashen to re-ignite past associations and shared nursing philosophies and interests. The origins of the present collaboration date back to 2003, when Springer was a graduate student at the University of Calgary.  At that time Dr. Ewashen, along with other members of the nursing faculty, initiated a philosophical discussion group that offered graduate students the opportunity to engage with faculty in the safety of informal monthly gatherings

Arlene Kent-Wilkinson

Arlene Kent-Wilkinson

to explore and solidify the philosophical underpinnings of their graduate thesis and dissertation research. Those informal engagements with faculty proved invaluable for Springer and remain a highlight of her graduate experience. Based on a keen desire to re-ignite past associations, and recognizing the value of philosophical discussion, reflection and debate for graduate students and for faculty, in the fall of 2012 this new cross-university collaboration was born!  Of note is that all four authors are alumni (Springer & Kent-Wilkinson), faculty (Ewashen), or a present doctoral student (Ali) of the Faculty of Nursing at the University of Calgary.  For Ali, the opportunity to contribute to this collaborative article was “a great experience”, one in which she has “learned so

Carol Ewashen

Carol Ewashen

much”!  Enriching the graduate student experience by providing the opportunity to engage with faculty to confront, inquire, disrupt, challenge, debate and share perspectives in the safety of an open, inviting, respectful, and truly collegial space is the purpose of this newly formed cross-university collaboration.

This article is available for free download while it is featured on the ANS web site!  Perhaps the experience of these authors will inspire you to also make the time for dialogue of a kind that inspires, challenges and informs!

Ruth Ali

Ruth Ali

Engaging with Nursing Theory

The current featured article by Marjorie McIntyre, PhD, RN and Carol McDonald, PhD, RN offers a significant perspective on the importance of understanding nursing theory and its philosophic underpinnings in practice. Their article is titled: Contemplating the Fit and Utility of Nursing Theory and Nursing Scholarship Informed by the Social Sciences and Humanities. They draw on their own experiences in nursing education and practice to present a framework to guide philosophic explorations that strengthen nursing practice and nursing education. Dr. McIntyre gives some background related to their work:


Marjorie McIntyre and Carol McDonald – photographer Robbyn Lanning

We were particularly thrilled to have this article published in the ANS as it is a reflection of three decades of curriculum work in nursing education and follows on and extends an earlier article published in the ANS in 1995. This article presents a philosophical framework as one possibility for organizing and interrogating knowledge, bringing together ontological assumptions of nursing with other vital epistemologies. While Carol and I have both been deeply influenced by the process of theorizing in our nursing practice, in more recent years we have come to see more clearly the place of philosophical thought in nursing. Indeed, the movement “beneath” theory, to philosophical underpinnings provides a way to more fully take up, to make meaningful the theoretical connections that are nursing practice. This opening from the extant nursing theories to broader philosophical underpinnings has created space to hold the meaning of theories from within and beyond the discipline, without relinquishing our disciplinary groundings. As nurses who have worked in highly interprofessional practice settings and have at times felt overshadowed by medicine or psychology, this work to express our theoretical situatedness, in a disciplinary sense has been closely connected to our experiences as nurses in practice and as nurse-educators.

While this article is featured, you can download and read the article!  Visit the ANS web site now and explore this and other articles in this issue!

Choosing contentment in the midst of life transitions

Susan Bonis’ featured article, which describes a philosophic (hermeneutic) study,  is an example of scholarship that some assume is far removed from the practical realm of nursing practice.  But to the contrary, this thought-provoking article sheds light on one of the most vexing challenges of human practice – how do people come to a sense of enduring serenity (contentment) in the midst of the disharmony created by serious health challenges?  As Dr. Bonis states in her article: “Evidence-based practices begin with understanding the science that underpins the discipline. Nursing is a human science; therefore, it is essential to understand the basic human phenomena that underpin being human, such as contentment.” (see page 274 of her article, available for free download until 9/30/12).

Dr. Bonis examined the published memoir of Dawn Prince-Hughes, a researcher of primate identity and culture.  The memoir, titled “Songs of a Gorilla Nation: My Journey through Autism,” recounts Prince-Hughes’ experience of coming to understand her own journey living with autism.  Dr. Bonis’ hermenuetic interpretation of the memoir, cast in the perspective of the nursing human becoming philosophic framework, provides the basis for her analysis of the experience of contentment.  As a reader of this article, you may not share for yourself the human becoming philosophy, but you will find connections between this philosophy and the most fundamental of nursing concerns.  For me one of the fundamental nursing concerns that this article addresses is that of promoting high-level wellness.  Dr. Bonis describes the process of  contentment as a paradoxical living calm-turbulence in challenging situations – a process that seems to me as central to the basic nursing concept of high-level wellness.  In her conclusion, Dr. Bonis states that “As humans live rhythms of contentmentdisharmony, contentment is glimpsed in serene and pleasurable moments of feeling listened to, understood, cared for, loved, and respected, as well as in moments when they trust, unburden, and laugh while all-at-once acquiescing to arduous situations.” (See page 282). What an inspiring image for nursing practice, and for the outcomes that I believe we all seek!

Let us know your thoughts and responses to this featured article!  Leave your comments here – and we will respond!

Aging, language and health care

How we talk and think about aging is something that most often is taken for granted.  This is not the case for Connie Madden and Kristin Cloyes who have investigated the language of aging in history, theory and research.  They point out in their featured article titled “The Discourse of Aging,” the experience of aging is common to all humans, but it remains poorly understood.  Their analysis reveals how the language of aging has shaped not only our general ideas about the “common” aging experience, but the research and theories related to aging.  Their analysis shows how language has tended to dichotomize how we think about aging as an either-or — living longer or living better.  Nursing, they believe, can make a significant contribution to understanding aging by bringing a holistic view to this experience, and challenge notions that perpetuate limited and stereotyping assumptions about aging. Here are some reflections from the authors about their work on aging:

Connie Madden: My interest in the language of aging has been fueled through my experiences as a nurse educator talking with students about their experiences and perceptions.  Through PhD course work as a student in the University Of Utah Hartford Center Of Geriatric Nursing Excellence, I have been able to expand my interest through exploring the relationship between language, perception and the practice of providing nursing care for older adults.  In a particular course, The Philosophy of Inquiry ,  Dr. Kristin Cloyes helped put those  pieces together  through examination of anti-aging and healthy aging language as it intersects in the larger aging discourse.
Kristin Cloyes: It’s always inspiring when a scholar is able to take the typical structure of a required course and shape it into something they really want to say, growing a field she or he is passionate about in new directions. In this case, the structure involved a required course paper in which I ask students toexplore a central concept in their area of interest, to identify common epistemological assumptions that shape the field and to explore how these assumptions stand up when viewed from differing frameworks. Connie used the paper to embark on an incisive analysis of assumptions about aging, and how these may shape nursing education. After I suggested that her thesis should be developed for publication, I was lucky enough for Connie to invite me to help expand and refine her ideas about the discourse of gerontology as an emerging area of study.
The credit on the illustration “The Seven Ages of Man” shown above reads:  Bartolomaeus Anglicus, Le Proprietaire des Choses tres Utiles … Paris 1510

Redefining the meta-language of nursing science

Due to technical difficulties with my webinar last week I decided to make a recording of my presentation that is now available as a YouTube video. The length is just under 30 minutes. I hope you will join me for “lunch” or “tea” to experience the video, and share your thoughts and critique here or on the NurseManifest Project blog.

This presentation covers some of the ideas from my recent paper “The Integrality of Situated Caring in Nursing and the Environment” published in the current issue of Advances in Nursing Science. I sincerely look forward to the dialogue that I hope this presentation and paper will provoke. Don’t be shy, please share your thoughts.

The “Cs” of Scholarship

Several years ago I created a kind of template to use in talking about some of the mysteries of good scholarship.  The handout I used made its way around the world and with some regularity I received requests for copies of the handout!  So in mythe letter C Editorial in ANS Vol 22, No 2, I published a version of this handout.  With permission of our publisher, I am presenting this once again here, along with yet another pair of “C’s”!

The “C’s” in this list represent contrasting traits that we seek in the best of scholarship.  Some of the pairs seem like contradictions, but in fact, they have a Read more

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