Philosophy of Nursing: a literature discussion

By Olga Petrovskaya

The end of the year 2013 saw a publication of a book, Philosophy of Nursing: 5 Questions,(1) that will be the reference point for many nurses in academia and beyond who are interested in nursing philosophy. In my view, this book opens a new page in the history of ideas in nursing as a field of practice, both clinical and academic, which requires an inquisitive mind and a skill of critical reflection. The editors, A. Forss (Karolinska Institute, Sweden), C. Ceci (University of Alberta, Canada), and J. S. Drummond (University of Dundee, UK), have selected 24 authors representing eight countries — nurses, philosophers, and social scientists—known for their contributions to the diverse field of nursing philosophy. One of the authors is my dissertation supervisor, Dr. Mary Ellen Purkis.(2)

Like each of the contributors, Dr. Purkis was invited to answer five questions: How were you initially drawn to philosophical issues regarding nursing? What, in your view, are the most interesting, important, or pressing problems in contemporary philosophy of nursing? What, if any, practical and/or socio-political obligations follow from studying nursing from a philosophical perspective? In what ways does your work seek to contribute to philosophy of nursing? Where do you see the field of philosophy of nursing to be headed, including the prospects for progress regarding the issues you take to be most important?

For my dissertation research, I study aspects of philosophy of nursing, or, more accurately, aspects of philosophy in nursing – the influences of Continental thought on nursing scholarship. No surprise, I was among a group of eager and early readers of this book. Below, I dialogue with Dr. Purkis about some of her ideas in the chapter. In the near future, we intend to develop this conversation and possibly seek to publish it.

OP: Mary Ellen, in the chapter you begin by recounting a story of your undergraduate education in the 1980s and the role that the Roy’s adaptation model (that guided your nursing school’s curriculum) played in that process. You note with appreciation the ability of this model to organize thinking and actions of a novice—and hence often anxious—nurse. Later, with a growing clinical and teaching experience you felt less need to return to this model and more desire to “look forward”(3) to other approaches to make sense of nursing practice (such as philosophical inquiry, social scientific research in the vein of Giddens, and Foucault-inspired theorizing). Despite this discovery—most notably during your doctoral studies—of such intellectual tools from outside of the North American “nursing theory movement”(4), you clearly do not want to forget the “nursing theory” period of nursing history. On the contrary—and I think this is a quite remarkable point — you regret the virtual absence, in the body of nursing scholarship, of the “effective…bridge”(5) between the ideas of the nursing theorists of the 1950s-1980s and a more recent corpus of publications (e.g., in Nursing Philosophy, Nursing Inquiry). You observe that this corpus often implicitly positions itself as a counter-movement to the “nursing theory” phenomenon without, however, explicitly articulating this relation. I think you find this trend problematic, and I agree with you. I came to view quality scholarship and a strong disciplinary tradition as an engagement with disciplinary ideas: not a romanticized preservation though as some would insist, but rather a critical re-reading. Like Sioban Nelson’s Care of the Sick(6), like John Paley’s “Caring
as a Slave Morality,”(7) like Margarete Sandelowski’s Devices and Desires(8) — all different in style, tone, and focus—but superb examples of such critical engagement with the history of nursing’s material and discursive practices. On the other hand, there is a view that a currently-waning appreciation for our disciplinary, nursing theory tradition might be restored if nurses who use theoretical tools from the humanities and the social sciences start writing new nursing theories in the image of the “extant theories.” What is your perspective on this issue? How exactly do you envision the “effective bridge”? Can you provide examples of scholars who, in your view, are successful builders of such bridges?

MP: I like the possibilities that you propose here Olga. Where an explicit engagement with nursing’s traditional theories has taken place, it has tended to be quite critical of those writings perhaps mostly so as exemplars of philosophical writing or their alignment with logical forms. I find these critical efforts initially interesting, as they illustrate places in the theorizing of nursing where the logic breaks down. Ultimately, I find myself disappointed, because they rarely, if ever, go all the way to the ground – or perhaps the “frontline” – to explore relationships between theoretical precepts and practice. More often, however, my frustration and therefore my interest in a “bridge” is that nurses – and others – who write about nursing practice are silent on the theoretical traditions that have historically framed the discipline of nursing, for example, behavioural psychology and the biological sciences. But of course, while
their words may be silent on theory (that is, they either deny any affiliation with the nursing theory movement or avoid mention of theory at all), their writing is entirely theoretical. And this is why the bridge, in my view, is so essential. Unless the influences of theoretical perspective are made explicit in our writing, we can never effectively set aside problematic theoretical positions in favour of positions that are more favourable to the improvement of practice. Of course this self-critique is an exhausting practice – but without it, we risk believing and acting as though we can transcend history, imagining we and our actions are not entirely historical. As for exemplars of such an approach, I think that your reference to Nelson’s work above is one such exemplar; Trudy Rudge’s work on wounds and Sarah Flogen’s work on stroke prevention care are other examples. These are, relatively speaking, small studies of practice – but they demonstrate a consciousness of nursing’s history of ideas and their impact on practice that I think represent the beginnings of bridge building.

OP: Thinking about the first part of your response, Mary Ellen, let me probe further. You refer to some criticisms of nursing traditional theories as being initially interesting but failing in the end, due to their obsession with the accuracy of philosophical language and “alignment with logical forms” rather than a concern about the frontline nursing practice. I think that certain critiques, most notably Paley’s thorough examinations of methodological problems of nursing phenomenology and Mark Risjord’s demonstration of a pervasive but unacknowledged influence of logical positivism on disciplinary nursing knowledge, actually do “go all the way to the ground.”(9) These analyses reach the practice ground, but the practice targeted in this case is academic: knowledge development, research, and publication. And it seems crucial to have, among other scholars, those whose strength is in pointing out the “logic break-downs” in our practice of research and writing, in order to improve it. Can we see it this way?

MP: Yes, clearly we must develop our adeptness at both reading and writing for and about nursing in ways that both explicate the theoretical traditions informing our thinking and then writing in ways that seek coherence within those traditions. But I still feel there is a large piece of this field that is about conceptualizing clinical practice itself that remains as a foundation – even all these 50 or 60 years after those early pioneers began the work of theorizing nursing.

OP: Thank you, Mary Ellen, for this conversation.

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1 Forss A., Ceci C., & Drummond J. S. (Eds.) (2013). Philosophy of Nursing: 5 Questions. Automatic Press/VIP.
2 Purkis M. E. (2013). Chapter 16: Mary Ellen Purkis. In Philosophy of Nursing: 5 Questions (Eds. A. Forss, C. Ceci, & J. S. Drummond),
157-167.
3 Ibid, 159
4 Ibid, 159
5 Ibid, 159-160, italics in original
6 Nelson S. (2000). A Genealogy of Care of the Sick: Nursing, Holism and Pious Practice. UK: Nursing Praxis International.
7 Paley J. (2002). Caring as a slave morality: Nietzschean themes in nursing ethics. Journal of Advanced Nursing 40(1): 25-35.
8 Sandelowski M. (2000). Devices and Desires: Gender, Technology, and American Nursing. UNC Press Books.
9 J. Paley, M. Risjord, and T. Rudge have each contributed chapters to the Nursing Philosophy: 5 Questions.

From the 2014 Spring Communiqué — Student Issue