Philosophy of Nursing
Why do we need a philosophy of nursing? During your coursework, nurses often have to write a paper about their personal nursing philosophy. Many students wonder what the point of it is. At moments when a patient is in cardiac arrest, or when a nurse is up to her elbows in bodily fluids, such fine points may seem unhelpful.
It is important for us to know why we do what we do. In addition, each discipline has to have a philosophical basis of some kind to guide decisions and to make explicit as many of its practitioners’ intuitions and beliefs as possible. Difficult choices do come up, and nurses in particular have to be prepared for them and not caught off-balance. In daily life we can often get by on unexamined assumptions, feelings, and habit. In the high-stakes, complex, personal world of nursing, however, that is not enough.
So we need to have a philosophy of nursing. It may begin with general ideas about why we think life is the way it is, how it should be, and why. When moving on to the particular area of nursing, we are urged to consider the purpose of the field and investigate how we think about what nurses do. We are told to try to discern the values and ethics behind our ideas.
A Problem With Nursing Philosophy
We may conclude early on that nursing helps people to maintain their health or to minimize suffering. As soon as we pass this point, however, we run into highly conceptual and abstract ideas that may start to seem detached from real life. Controversy over whether health means “flourishing”, or whether it is a “right” or an “ideal”, is endless and seems impossible to resolve. We need the philosophy but we are unable to produce it.
In a positive development, recent thinking is focusing more on health and how to understand it, but it continues to construct elaborate concepts that may be difficult to hold in one’s mind in a crisis. We are expected to deliberate on ethics and morals, values and social obligations. These ideas seem important but require concentration to hold in one’s mind. In an emergency, that concentration may be unavailable. If the purpose of a philosophy of nursing is to help us take the optimum action in difficult circumstances, then that purpose is not being fulfilled if the philosophy flies out the window just when it is needed most.
Even so, one such concept may give us a clue to a way out of this predicament. That concept concerns the way we think of the human being. What if we look beyond philosophy? What does science tell us about this question?
A Way Forward Through Science
We know that the brain is the seat of our ability to think and function as a personality. In fact we know quite a lot about the details of brain function. One fact which has emerged is that at least three sets of mental activity have to occur for us to function. First, our thinking is carried on by one set of brain circuits. Second, functions related to emotion operate through a different set of circuits that often conflict with the first. Finally, both thinking and emotion get their information from our perceptions, which are filtered through templates enabling our brains to match patterns of stimuli and interpret them.
What this means for our question is that we must take these brain functions into account if we hope to arrive at a philosophy to guide us. What are some implications of these facts?
The Trouble With Nominalizations
For one thing, we are accustomed to using words like obligations, values, ethics, rights, and morals. We treat these words as nouns, unconsciously assuming that where there is a noun, there must be a corresponding entity out there in the world. Here is the source of the problem with conceptualizing that we just encountered. These words are abstractions. Most of the time, “abstractions” are couched in “nominalization”.
Nominalizing is the process of turning a verb or adjective into a noun. “Obligation” derives from “to oblige”, which in this connection means to make someone morally or legally bound to take an action. This begs the question of who is making the “someone” bound, and to what action in particular. There are no abstractions in the world, only specific entities and actions. Moreover, when we say “obliged”, we assume that the listener shares our assumptions about who initiates the obliging, who is obliged, and to what.
“Value” as a noun, used as it is in ethics, often means something treated as a priority in decision-making. It derives from the verb “to value”, meaning assessing “worth”, assigning monetary tallies, or esteeming highly. “Worth” is itself another nominalization, and the definitions continue in a chain of nominalizations built atop one another. We assume the identity of the individual who assesses, the method of assessment, and many other factors.
We can see that just in these two words, “obligation” and “value”, we have already stumbled into a mire of unexamined assumptions which are virtually never shared between speaker and listener. As a result, effective communication is the exception rather than the rule. What about “health”? This interesting word derives from “to heal”, which immediately opens a bundle of assumptions. Is “heal” reflexive, as in “She healed”, or transitive as in “She healed him” or “He healed himself”? Is it even possible to “heal another”? Also, is “health” concerned with “healing” or with preventing the need to “heal” from arising at all?
The Quick And The Quicker
These problems can be partly avoided by becoming aware of nominalizations and their unwatched-for influence on conversation and thought. However, another factor in the situation can obstruct this awareness. The semi-autonomous brain circuitry responsible for emotion works far faster than the circuitry that modulates thought, being an older and more immediately survival-oriented part of the brain. When emotion is aroused, the thinking brain circuits are jammed, inhibited and shunted aside so that the organism can respond with maximum speed in simple emergencies.
When this jamming occurs, most of the more recent and refined aspects of mental operation effectively shut down. A common example is the well-known case of people being unable to dial emergency numbers on the telephone keypad because they cannot use fingers individually due to stress. A less recognized but even more common example is the way all of us regress to more primitive modes of thought when under perceived attack, physical or not, real or not. We become temporarily simple-minded, either-or thinkers.
Nominalizations tend to make this jamming occur more easily because they distract our thinking mind. It takes more mental processing to decode a nominalization than a straightforward verb. We have to try to guess who the omitted actors and other players are for each nominalized word such as “ethics”. The problem is similar to when people talk on a cell phone while driving. While we are distracted, emotional arousal can sneak up on us and surprise us, rendering our thinking primitive just when it might need to be the most sophisticated.
A Nursing Philosophy Worth A Pound Of Cure
How can we protect our thinking from being shut down in a crisis so that we can make use of the very delicate and intricate ethical frameworks needed to guide us in that crisis? We need to learn at least two skills: an ability to calm our emotional minds and an ability to notice the jamming before it takes us over. Most of the solution is simply being aware of the issue and recognizing the ways it occurs and how it feels when it happens to us. The rest of the answer is to practice unpacking nominalizations when we encounter them, and also to learn our own hot buttons so that we are forewarned rather than taken unawares.
With that problem out of the way, we can devise a simple personal philosophy of nursing that we can easily keep in mind and apply. This framework is based on human needs as identified by science rather than by non-evidence-based ideologies. The basic needs appear to include food/water/shelter, control/autonomy, security, connection to other people, emotional intimacy, privacy, status, achievement, purpose, among others. All of these needs have to be met for optimal health, so we can assess how well each course of action will succeed in meeting them in balanced ways. We can watch for cases where one or more needs are neglected in favor of other needs, and seek alternative solutions that will avoid such conflicts.
Our ethical frameworks can be enriched and brought down to earth by adding this needs dimension to them. If we add to our ethical considerations a combination of the needs assessment together with an awareness of the best ways to utilize our own mental instruments, we stand a good chance of making high-quality decisions worthy of our ethics and our values.