The key teaching theories, ethical principles, and evidence-based strategies that shape effective nursing instruction and promote critical thinking. Philosophical Foundations for Excellence in Nursing Teaching.
Nursing Theory and Theory From Other Disciplines
Theory is generally taken to mean scientific theory that explains human experiences that can be measured or accessed through the physical senses. Experiences that are not strictly physical, or that are hard to observe, such as hope or grief, for example, are addressed in empirical theory in ways that point to observable dimensions of the experience, such as posture or motions, verbal or facial expressions, or sequences of behavior. These kinds of theories typically constitute what nursing philosophies refer to as the foundation for nursing practice.
The “Sciences” in General
Many nursing philosophies specifically state that nursing is based on the more general physical and human sciences. Rarely, a philosophy will also mention the arts and humanities as a foundation for nursing practice.
Medicine
Medicine is generally assumed to mean a practice based on scientific theory that addresses pathophysiology and pathopsychology. Many nursing philosophies include medical science as a foundation for nursing practice. If you do not find this in the philosophy you are examining, make a special note of this omission. Later, when you examine the course content, you may find a stunning disconnect a large emphasis on medical theory in the actual course content outlines.
Ethics
Ethical considerations usually appear in a school’s statement of philosophy. As you examine your philosophy, consider which of the following dimensions of ethical knowing are included: rights and justice, responsibility, integrity and ethical compassion, and caring as a moral imperative.
Rights and Justice
Nursing philosophies often include a statement that acknowledges the right of all people to health or health care. Or, you may see statements concerning what people deserve in terms of respect, regardless of various personal dimensions, such as socioeconomic status, race, religious belief, and so forth.
Responsibility
Many nursing philosophies address the responsibilities of the nurse, dimensions of professionalism, obligations to serve, and accountability for one’s own practice. Advocacy for the rights of patients is a common ethical dimension for nursing.
Integrity and Ethical Commitment
Statements that refer to the nurse’s obligation to act with integrity and within the cultural expectations of morality are usually not specific to a particular moral or ethical standard, but refer more generally to conduct that meets general ethical standards, such as honesty, truth-telling, abiding by legal requirements of practice, and so forth.
Caring as a Moral Imperative
The moral obligation to care is often subtle. It is assumed in statements that refer to the nurses’ obligation to care for people regardless of race or creed, for example. There is a slight but important difference in a statement that says a nurse is obligated to have compassion and respect for others, and one that states that a nurse is obligated to care for others in all circumstances. Occasionally, you will find statements in nursing philosophies that indicate that a nurse is not obligated to care for a person when, for example, the nurse’s religious beliefs conflict with the care that is required.
Personal Knowing
Personal knowing is not often included as an explicit part of a school’s philosophy. Personal knowing is the inner experience of becoming a whole and genuine self. Personal knowing is essential for engaging in a caring and healing encounter with another. Statements that refer to the nature of the nurse as a human being and as one in relation to others imply beliefs related to personal knowing. Elements of a philosophy that reflect personal knowing include: reflective practice, therapeutic use of self, and the unique nature of human beings.
Reflective Practice
Statements that refer to the development of expertise in nursing infer a kind of practice that develops through personal reflection on one’s own practice, resulting in gaining personal insight, meaning, and growth arising from the practice itself (Schön, 1987).
Therapeutic Use of Self, or Self-in-Relation
In principle, many nursing philosophies explicitly state, or tacitly assume that a large component of nursing involves the therapeutic use of self, or the nurse’s ability to enter into a dynamic human relationship with others that is directed toward caring and healing.
Unique Nature of Human Beings
Many nursing philosophies hold the tenet that human beings are unique and individual. This statement is usually in a context that also addresses respect for the uniqueness of the other person, often without specific reference to the idea that the nurse is also a unique individual. Any general statement about the uniqueness of individuals also implies that in order to know and understand another’s uniqueness, one must know the self.
Aesthetics
Aesthetics is closely related to personal knowing in that both are concerned with a dimension of uniqueness. Aesthetics, however, concerns the ability to discern the deeper meaning of a situation, and the creative ability to respond to a situation in its wholeness. It is the ability of the nurse to bring forth something that is possible in a situation, and that without the nurse would not be possible. Philosophical statements that reflect aesthetic knowing include: creativity in practice and the transformative nature of nursing.
Creativity in Practice
Creativity and the art of nursing practice is not typically included in the philosophies of schools of nursing, but there may be statements that could link to this important component of nursing. Even the premise that each person is unique implies that an element of creativity is necessary in an interaction that occurs between two or more people. Statements that refer to the importance of culture imply the ability to discern cultural meanings and to be responsive to different cultures.
Transformative Nature of Nursing Practice
When nursing is viewed as a practice that has its own foundation and purpose, and not one that is dependent upon the practice of medicine, then nursing acquires agency as a practice that can transform reality, or bring forth changes toward health, healing, and wellness .
Philosophical statements that refer to a purpose of nursing, such as achieving high-level wellness, peaceful death, or healing and well-being, imply that the nurse has the ability to engage in a kind of creative practice that is responsive to what is, but that experience moves towards a new and different reality.
Sociopolitical Knowing
Sociopolitical knowing concerns context and environment. Most philosophies of Schools of Nursing include statements that acknowledge the importance of one’s context as inherently significant to health and well-being. Statements that relate to sociopolitical knowing include: culture, family and community; natural environment; socioeconomic aspects of health; and governmental, organizational, and political structures.
Culture, Family and Community
These aspects of a person’s context are generally regarded as inherent in the idea of “ wholism ,” which assumes that a person cannot exist in individual isolation, but as one who develops within, and participates in developing, a meaningful social network.
Natural Environment
Although generally it is assumed that the natural environment plays an important role in health, it is usually neglected as a component within philosophies of nursing education (Kleffel, 1991). Examine your philosophy for statements that point to the importance of a clean and healthy environment, which are supported by a sociopolitical will to protect and nurture the physical environment.
Socioeconomic Aspects of Health
Like the natural environment, socioeconomic factors are generally understood as related to health and well-being, but explicit reference to socioeconomics is rare. Your philosophy might address this aspect of health indirectly, for example in acknowledging the right of individuals to receive care regardless of socioeconomic status. Missing in this kind of reference is the idea that a nurse might have a role to play in changing the contexts in which socioeconomic factors are a detriment to human health and well-being.
Governmental, Organizational, and Political Structures Political structures
are closely related to culture and community, but they are not the same thing, and these structures are at the heart of determining health-care rights, services, quality of care, and opportunity for participation in decision-making. Examine your philosophy for elements that refer to the nurse’s role as an advocate, or that position the nurse as an agent in determining the quality of care, as a leader and change-maker, or as an active participant in the community.
Also look for statements that position all people as creators, participants, and decision-makers in their own health care. Although many of these statements do not explicitly address organizational and political structures, they set the stage for active participation and influence in such structures.
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