Philosophy Of Nursing
ÚÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄ¿ ³ ³ ³ Philosophy of Nursing ³ ³ ³ ³ ³ ³ ³ ³ ³ ³ ³ ³ ³ ÀÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÙ PHILOSOPHY OF NURSING Quality of Life Nursing as a profession has as its center the quality of human
life. In contributing to the quality of life, it has two general spheres of activity: society, and the life of the individual. Socially, the nurse acts as citizen and as professional. For the individual client, the nurse acts as a professional who brings an array of knowledge, skills, activities and resources to assist the client to define and realize appropriate health care goals. Social Activity Nurse as Citizen Socially, the nurse acts to advance the common quality of life,
and to set environmental and health standards applicable either to society as a whole, or to groups within society. This participation in the common life is a modern expression, by a single profession, of the ancient Greek concept of parrhesia (free speech), by which one participates in the life of the “city” (polis) as a duty, a right, an honor, and a matter of personal honor.
The nurse as citizen bears witness to the value of human life, and to the priorities of humanity whereby each human person is seen to be a unique and valuable resource for the human family as a whole. In participating in the establishment of public policies on health and sanitation, standards of health care delivery, availability of life-saving technology, provision of the basics of life to all peoples,
child care and maternity leave, equal rights and comparable worth, and a
myriad of other concerns, the nurse carries this witness over into real action in the real world. Guiding the realization of this witness is the understanding that the extension of the human powers of any person, or of any people, is an extension of the powers of the human family as a whole, for the common good, ultimately — the individual good and the common good are seen as dynamically one, as expressions and moments of one another. Nurse as Professional The nurse acting publically as a professional first of all tries
to convey to the public, to colleagues, and to other professionals, the nature and scope of nursing. And engages in education of the public on specific health care matters, as well as carrying on pro bono work related to the profession.
Within the profession, the nurse works to establish appropriate standards and policies, and to advance the profession as a whole.
The professional nurse advances the knowledge and art of nursing by actively participating in the research process, whereby new knowledge is generated or disseminated, or where old knowledge is set on firmer ground, or abandoned.
The professional nurse actively seeks to advance other nurses within the profession, to encourage and support them, to recruit new people for the profession, and to advance nursing education generally.
Individual Client The “individual” client may be an individual, a family, a group,
but most likely will be a patient and that patient’s family. The professional nurse encounters the patient as a fellow citizen, as a brother or sister, who has need of the particular knowledge and skills that professional nursing offers.
Rather than a consumer, the patient (client) is seen as a person who acts on the real world, alone or through others, to define needs and meet them, to define goals and achieve them. It is for the nurse to assist in this process, or to act for the patient if no one else can or will, attempting to the greatest extent possible to facilitate the human life of the patient, to increase or maintain the human quality of that life, and where nothing else is possible, to bear witness with the patient to the worth of that life, in bearing its pain and its passing. And to do this without fear, cynicism, or despair. Self-Care The nurse does not “do” for the patient, but consults with, plans
with, and assists the patient in carrying on a self-directed life, in “doing” for self. A patient competent to live in the real world is competent not only to obtain and participate health care, but to do as much of it as would be done outside the institutional setting normally. Self care, the maintenance of all possible capacities, and the development of capacities, are critical to this aspect of nursing. Orem’s self-care model begins to address future forms and structures of
nursing, but it is also clear that nursing also addresses the question
of “rehabilitation” from “day one, moment one” with regard to certain patients, certain conditions. Rehabilitation, like sanitation in the preventative, public sphere, is an underlying concept for all nursing care, and closely linked to the question of self-care. And, like rehabilitation in its own sphere, teaching and consultation will become increasingly central to nursing practice. For, nursing under a self-care model involves intensive work with clients, not less time or attention. But it can also hope better outcomes, and shorter periods of need. Nursing’s Own Sphere The quality of life is not the task of nursing alone, and nursing
carries on its functions in collaboration with others, and increasingly realizes its own unique tasks within a multidisciplinary environment. Nor is the concern with the “whole” patient — the human person in society, as a total person — unique to nursing. In attempting to identify better “what” nursing does, the American Nursing Association (ANA) has described nursing as acting upon human responses to actual or potential health problems, and the North American Nursing Diagnosis Association has moved toward a theoretical taxonomy of pathophysiology, diagnosis and intervention which at once provides some basis for recognition of both the independent and interdependent aspects of nursing practice. For advanced nursing practitioners, the grouping of tasks has been described by the ANA and others in terms of for areas of
professional activity: clinical practice, education, consultation, and
research. To these four, many would add: administrative functions. Each of these efforts to define the range of the nursing process, and to categorize its functions for the advanced practitioner, has its problems. But, for now, these are the best and most inclusive statments to emerge, and will suffice for an entry to practice, if properly used.
Whatever nursing may finally decide its unique role is, it is clear that nursing can and must act in its own name, in its own right, and on its own authority and responsibility, to define for the person and the society what human existence is worth, and what a human quality of life may be. Others will have their say also, but nursing must be certain its voice is not lost in that broader discussion, for its potential contributions to that discussion are rich and varied.