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Edwards-1997-Journal of Advanced Nursing
Edwards-1997-Journal of Advanced Nursing
obviously the case that philosophy involves the proposal p. 15). Given the centrality of human beings to the nursing
of any definite claims. Rather, she suggests that philosophy enterprise this is evidently a plausible claim.
might best be characterised in terms of its methods and its In spite of the excellence of Salsberry’s paper, a worry
problems (Schrock 1981b). As may be seen, the claims remains. Why is she concerned to set out a philosophy of
made in the present paper lend broad support to Schrock’s nursing rather than to characterise philosophy of nursing
suggestion. per se? The claim that one is developing a philosophy of
More recently, Simmons has offered the following nursing clearly implies that there are other possible philo-
definition of philosophy sophies of nursing. The title of Salsberry’s paper (A philos-
ophy of nursing: what is it? what is it not?) suggests that
By philosophy, I mean knowledge of first causes or of the highest she is out to characterize one member of a class — the
principles of things in so far as these causes or things belong to class of philosophies of nursing — as opposed to setting
the natural, as opposed to the supernatural, order out, more generally, the criteria for membership of the
(Simmons 1992 p. 112) class. In other words, she deliberately omits to give an
account of philosophy of nursing in favour of giving an
She goes on to add that this, more properly, should be
account of one particular philosophy of nursing.
understood only as a definition of metaphysics.
Simmons offers no reference in support of her definition,
and as it stands it seems vulnerable to some quite serious Ideology and philosophy
objections. First, sceptical philosophers doubt that it is
The reasons why it matters whether Salsberry is charac-
possible to obtain any knowledge of anything (Ayer 1956).
terising philosophy of nursing and not merely a philos-
So a (philosophical?) claim to the effect that one could not
ophy of nursing are these. First, the expression a
be certain of the existence of anything would not count as
philosophy of nursing brings to mind the confusion to
philosophy by Simmons’ criterion. Hence she seems
which Schrock draws attention, namely, that between an
wrong to restrict philosophy to knowledge of first causes,
ideology of nursing and philosophy of nursing. The reason
or indeed, to knowledge of anything else. Second, her
that the expression ‘a philosophy of nursing’ may lead to
definition seems to omit large chunks of the works of
such a conflation stems partly from the currency of
Descartes and Plato. Each of these philosophers discuss
expressions such as ‘I like your philosophy’ or ‘what is
extensively phenomena which lie beyond the natural
your philosophy?’. These colloquial uses of the term are
world. Apart from discussing God, Descartes (1970) fam-
far removed from academic philosophy (Schrock, 1981b).
ously argued for the existence of a spiritual mind-stuff.
Second, and perhaps more seriously, the question ‘what
Plato (1955), equally famously, posited the existence of a
is a philosophy of nursing?’ neglects to address what is
world of forms beyond the natural world. So it seems
clearly the prior question: ‘what is philosophy of nursing?’.
plausible to claim that Simmons’ definition of philosophy
The priority of this second question is evident since, as
(or even metaphysics) is open to very serious objection.
noted, any one specific philosophy of nursing can only be
an instance of the subject-area denoted by the expression
Three components ‘philosophy of nursing’.
It seems, then, that there is some disagreement amongst
In an excellent paper, Salsberry (1994) tries to set out what
nurse theorists regarding the answer to the question of just
is described as a philosophy of nursing. This involves, she
what philosophy of nursing is. It is the burden of the
suggests, three components. First, an ontology which
remainder of this paper to try to shed some light on the
informs us what the fundamental entities are that exist within the answer to this question.
domain of nursing
(Salsberry 1994 p. 13) WHAT IS PHILOSOPHY? PHILOSOPHERS
SPEAK
Second, an epistemology which involves ‘claims about
how the basic phenomena can be known’ (Salsberry 1994 It was noted earlier that if applied philosophy is a part of
p. 13). And third, an ethics: ‘statements about what one philosophy, then philosophy of nursing must be also. An
values’ (Salsberry 1994 p. ??). Salsberry suggests that these answer to the question of what philosophy of nursing is
three components comprise the form of a philosophy of presupposes an answer to the question of what philosophy
nursing as opposed to the substance of such a philosophy. is. However, as Schrock (1981b) points out, there is dis-
The reason is that identification of these three components agreement amongst philosophers concerning the answer
leaves open precisely how they may be completed. For to this question. One quite narrow conception is the
example, with respect to the ontological component, the so-called ‘underlabourer’ view of philosophy which
substance of that component is likely to include ‘content derives from Locke (1690). According to this view, philos-
regarding the nature of human beings’ (Salsberry 1994 ophy is to be characterised in terms of the methods it
1090 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093
Philosophy of nursing
employs and in terms of the purposes for which its draws attention. Roughly, the character of such questions
methods are employed. Roughly, the relevant methods can be exemplified in two ways. The first exploits a con-
include conceptual analysis and assessment of argument. trast between philosophical and scientific questions. For
The purpose behind the application of these methods is example, Bird (1972) draws attention to the following
that of ‘removing impediments to the advance of our quote from Peters
understanding’ (Winch 1958 p. 4). This might consist in
A scientific question, for instance, is one that can in principle be
drawing attention to inconsistencies in the claims of nurse
answered by certain kinds of procedures in which observation
theorists, or to conceptual unclarity in their writing.
and experiment play a crucial part. But the clarification and dis-
A difficulty with the underlabourer conception, raised
cussion of the concepts used and of how they have meaning,
by Winch, is this. The underlabourer view leaves philos-
and of the procedures by means of which these questions are
ophy without any subject matter of its own. As Winch puts
answered, is a philosophical enquiry
it, ‘On this view philosophy is [entirely] parasitic on other
(Peters 1966 p. 16)
disciplines’ (Winch 1958 p. 4). This is the case since on
the underlabourer view the tasks of philosophy are set by Very crudely, the claim here is that scientific questions
claims made in other disciplines. These claims provide are characterised by agreement concerning what is sought
the subject matter of philosophy. and how it can be sought. So, for example, given an agreed
Winch points out that the underlabourer conception definition of, say, schizophrenia, an epidemiologist may
cannot provide an exhaustive account of philosophy. The be able to plot the incidence of that condition in a given
reason is that two of the main areas of philosophy, meta- population. But philosophical questions focus on the con-
physics and epistemology, are characterised by problems cepts presupposed in such a procedure. Most obviously,
which are distinctly philosophical. For example, the con- these will include those of schizophrenia and illness. Less
cerns of metaphysics centrally include existence-questions obviously, they will include the concept of a person. As
such as: do I exist? are there other selves? are there physi- Schrock indicates, it is evident that scientific questions
cal objects? is there an external world? Clearly, these are and methods presuppose certain philosophical questions.
not questions which figure centrally in other disciplines. These will include tacit agreement regarding what is to
Rather, it is the case that answers to such questions are count as an instance of a particular concept (in the
presupposed in other disciplines. For example, all the sci- example just given this is schizophrenia); and also tacit
ences presuppose an answer to the question: is there an agreement upon how to proceed in order to make such
external world? And human psychology presupposes identifications. The former task, in philosophical terms, is
the existence of persons. So Winch’s case against the an ontological task; the latter task is an epistemological
underlabourer view seems a convincing one. one.
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093 1091
S.D. Edwards
propositions themselves. So in relation to our present cal problems (e.g. those of metaphysics and epistemology).
example, the question ‘are there physical objects?’ counts And the third element of philosophical enquiry involves
as an external question. It is a question addressed at the the development of a criterion for the identification of
level of the framework as a whole. philosophical questions. Such questions are those which
Carnap (1950) proposes that such external questions are, Carnap describes as external questions.
in fact, philosophical questions, their distinctive, philo- The identification of these three elements of philosophi-
sophical character derives from the fact that they are cal enquiry supports the proposal that philosophy of nurs-
directed at very basic presuppositions; presuppositions ing should similarly be comprised of the three elements.
upon which the intelligibility of discourse within the That is, if philosophy involves these three elements, then
relevant linguistic framework depends. so too must philosophy of nursing. In this context philos-
ophy of nursing would be said to involve the following.
First, conceptual clarification and assessment of argu-
Nursing discourse
ments. Second, consideration of traditional philosophical
Carnap allows that linguistic frameworks need not be so problems which have relevance to nursing theory and
general as that just discussed. And this is a view which practice (clearly, this relevance would need to be made
has been developed by, for example, Wittgenstein (1979). explicit). And third, in the light of our discussion of
It can be claimed that nursing discourse constitutes a Carnap’s claims, it can be asserted that the concerns of
linguistic framework. Its intelligibility presupposes the philosophy of nursing would include a focus on the frame-
truth of certain general claims which can be termed frame- work propositions which constitute nursing discourse
work propositions. Obvious examples of such framework and on the concepts of which those propositions are
propositions include: ‘There are nurses’, ‘There are comprised.
patients and clients’, ‘Illness exists’; ‘Health exists’; ‘There Consider, then, Salsberry’s claims regarding a philos-
are disease-entities’ and so on. As is implied by Salsberry’s ophy of nursing in terms of this account of what philos-
paper, these framework propositions characterise, at least ophy of nursing amounts to. The charge made above
partly, the ontology of nursing. against Salsberry is that she neglects to consider the prior,
Given acceptance of the claim that nursing discourse is more general question of what philosophy of nursing is.
a linguistic framework, examples of both internal and
external questions can be identified. An example of an
Conceptual clarification and assessment of
internal question is ‘Is Smith a nurse?’ An example of an
argument
external question is ‘Are there such things as nurses?’ This
question has the philosophical character which Carnap It seems to me that the characterisation just offered of phil-
identifies in external questions. Evidently, in order to osophy of nursing sits rather well with Salsberry’s descrip-
answer the external question just posed is it necessary to tion of a philosophy of nursing. For, a philosophy of
examine what being a nurse amounts to — to answer the nursing, if it can be formulated, must arise from appli-
question, ‘What is a nurse?’ cation of the three elements of philosophy of nursing
The claim being put forward here, then, is that questions identified above. Evidently, formulation of a philosophy
which focus on the framework propositions of linguistic of nursing must involve conceptual clarification and
frameworks are philosophical in character. This character assessment of argument. For example, such clarifications
is evidenced by the fact that they are directed at the pre- may focus upon the concept of a nurse, or of a patient etc.,
suppositions of the linguistic frameworks as these are set and on arguments deployed in support of particular con-
out in framework propositions. It should be added that clusions. Further, a philosophy of nursing can be expected
questions regarding the understanding of the concepts to take into account relevant traditional philosophical
which constitute framework propositions also count as problems.
philosophical questions. So, for example, in relation to For example, as Salsberry suggests, the ontological com-
nursing discourse an examination of the concept of a nurse ponent of a philosophy of nursing must include human
counts as a philosophical examination. For, the concept beings, or persons. Hence, any such component must take
nurse features in the framework propositions upon which into account the traditional philosophical problems of per-
nursing discourse depends for its intelligibility. sonal identity and of the relationship between the mind
and the body. Also, sensitivity to the distinction which
Carnap raises between internal and external questions
W HAT IS PHILOSOPHY OF NURSING?
must also be present in the formulation of a philosophy of
So far, three elements of philosophical enquiry have been nursing. For, the propositions and concepts which com-
identified. The first is the kind of analysis which comprises prise the linguistic framework of nursing discourse will
the underlabourer view. The second is the concern with be the focus of philosophical enquiry in nursing. And for-
particular problems traditionally regarded as philosophi- mulation of a philosophy of nursing will necessarily
1092 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093
Philosophy of nursing
involve the development of such framework prop- Meaning and Necessity, University of Chicago Press, London,
ositions — what Salsberry describes as the substance of a pp. 205–221.
philosophy of nursing as opposed to its form. Descartes R. (1970) Philosophical writings, Geach P.T. &
Anscombe E. (eds), Open University Press, Hong Kong.
Locke J. (1690) Essay concerning human understanding,
CONCLUSION Everyman, London.
Marriner-Tomey A. (1994) Nurse theorists and their work,
At the start of this paper two possible audiences were Mosby, London.
referred to, philosophers and nurse theorists. It is hoped Peters R.S. (1966) Ethics and Education. Allen and Unwin,
that the above articulation of philosophy of nursing will London.
persuade those philosophers who are sceptical of the legit- Plato, (1955) The republic, Lee D. (ed), Penguin, Harmondsworth.
imacy of such an enterprise that it is founded upon respect- Salsberry P.J. (1994) A philosophy of nursing: what is it? what is
able and fundamental philosophical traditions. it not? in Kikuchi J.F. & Simmons H. (eds), Developing a philos-
These include the activities of conceptual analysis and ophy of nursing, Sage, London, pp. 9–225.
assessment of argument, concern with general existence Sarvimaki A. (1995) Knowledge in interactive practice disciplines,
Stockholm University College of Health Sciences, Stockholm.
and knowledge questions; and the recruitment of Carnap’s
Schrock R. (1981a) Philosophical issues. in Current issues in nurs-
internal/external questions distinction to aid identification
ing, Hockey L. (ed), Churchill Livingstone, Edinburgh,
of philosophical questions.
pp. 3–18.
Finally, it is hoped that the articulation of philosophy Schrock R. (1981b) Philosophical perspectives, in Nursing science
of nursing attempted in the paper is also of help to nurse in nursing practice, Smith J.P. (ed), Butterworths, London,
theorists. pp. 170–184.
Simmons H. (1992) Philosophic and scientific inquiry: the
interface, in Kikuchi J.F. & Simmons H. (eds), Philosophic
inquiry in nursing, Sage, London, pp. 9–25.
References
Warnock M. (1992) The uses of philosophy, Basil Blackwell,
Ayer A.J. (1956) The problem of knowledge. Penguin, Oxford, pp. 2–3.
Harmondsworth. Winch P. (1958) The idea of a social science, Routledge & Kegan
Bird G. (1972) Philosophical tasks, Hutchinson, London. Paul, London.
Carnap R. (1950) Empiricism, semantics and otology in Carnap R. Wittgenstein L. (1979) On certainty, Basil Blackwell, Oxford.
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093 1093