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Importance of Philosophy and Philosophizing for Nurses

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Importance of Philosophy and Philosophizing for Nurses

Author: Raisa Gul, RN, RM, MHA, PhD

Associate Professor, Aga Khan University School of Nursing

October 28, 2009

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 Importance of Philosophy and Philosophizing for Nurses

The infinite treasures of thinking and reasoning are located within human minds;

however, some humans are more fortunate than others in regard to using their potential powers.

Those who use them in sophisticated manner are called philosophers, a term originated from

ancient Greek (philos—love; sophia—wisdom) meaning ―lover of wisdom‖. The purpose of this

paper is to advance the importance of philosophy and philosophizing for nurses. To achieve this

goal, I highlight the value of philosophic inquiry in nursing and demonstrate its application in

nursing practice. For nursing to be regarded as a distinguished scientific discipline and to aspire

for the development of a meta theory, understanding of philosophical questions and

philosophical method of inquiry cannot be ignored. In order to understand and appreciate the

value of philosophy in nursing inquiry, it is appropriate to begin the discussion with what

philosophy is and what philosophical inquiry seeks to achieve before discussing the importance

of philosophy and philosophical thinking for nurses. Moreover, I compare the philosophical

method of inquiry with that of the scientific method followed by some recommendations. I posit

that philosophical inquiry is foundational to the discipline of nursing and is complementary to

scientific investigation. However, it is not the focus of this paper to address what is or should be

a philosophy of nursing or of nursing science.

Conceptions of philosophy and philosophical inquiry may be interpreted in various ways

by different people and for different uses. Philosophy may be referred to as a statement of beliefs

and values about the world, a perspective on human beings and their world, or as a mode of

inquiry for answering certain questions(Kikuchi, 1992; Simmons, 1992) and hence knowledge

development, or ―…the study of the universe at large and the world of human affairs‖ (Fry,

1992, p. 87). When the term ―philosophy‖ is used in connection to an individual, it includes the

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individual‘s values or ideology. Edwards (1997) defines ideology as ―a set of unexamined

presuppositions which influences attitude and practices‖ (p. 1089) of the individual.

Consequently, ideology reflects individual‘s values in their manner of thinking, but it is not

limited to individual values. However, in the academic sense, philosophy is viewed as a

framework of action for a discipline that constitutes logically related ontological, epistemic, and

ethical claims (Conroy, 2001; Edwards, 1997;Kikuchi, 1992; Salsberry, 1994). It is vital to

consider these aspects when determining or articulating a discipline-specific philosophy. In other

words, philosophy is fundamental in delineating the nature scope, and end goal of nursing.

Ontological claims identify fundamental entities or basic phenomena that exist within the

domain of a discipline (Salsberry, 1994), such as the concepts of “person” and “health” in the

discipline of nursing. Epistemological claims, whether explicit or implicit, relate to ―how the

basic phenomenon [person or health] can be known‖ (p.13), hence, considered essential for the

nature of knowledge development in a discipline. Ethical claims or statements about the values

and beliefs of the discipline is an important part the philosophy (Salsberry) because it dictates the

directions and prescriptions for actions of any discipline. Therefore, in the academic sense,

philosophy is different from ideology. Likewise, Salsberry warns that philosophy should not be

mistaken for ―the equivalent of methods‖ (p.18), but rather it frames the posed question(s) as

well as the methods or approaches pertinent to the nature of the phenomenon of a discipline.

Philosophy and Science as Branches of Knowledge

The origin of philosophy can be traced back to 300 BC with the remarkable progress

made by its pioneers Plato and Aristotle (Adler, 1978). Mautner (1996) defines philosophy as ―a

theory resulting from a rational inquiry‖ (p. 319). Based on its focus of study, philosophy

includes but is not limited to multiple sub-disciplines: moral philosophy or ethics—concerned

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with the principles of human action or conduct; metaphysical philosophy—concerned with

ultimate reality or the most general causes and principles of things; and natural philosophy—

concerned with the study of nature, natural objects, and phenomena. Since the 17th century,

natural philosophy has been called science (Oxford English dictionary, 2003). Simmons (1992)

describes that both, science and philosophy have at least three major subdivisions. Accordingly,

the major division of science is known as pure (natural and social), applied and practical.

Likewise, the major branches of philosophy are viewed as logic, speculative, and normative

philosophy. Speculative philosophy provides knowledge about what happens in the world it can

be further divided into metaphysics (ontology), natural philosophy, and epistemology. Normative

philosophy focuses on knowledge about ―what ought to be done‖ and its further branches

comprises of ethics, economics, and politics (For detailed discussion of the branches, readers are

referred to Adler, 1965; Wallace, 1977).

In Adler‘s (1965) perception, Aristotle believed that science is knowledge or real truth

which is different from subjective knowledge or opinion. Following Aristotle‘s writings, Adler

differentiated between two distinct modes of truth– descriptive and prescriptive truth. The

descriptive mode of truth is philosophical knowledge of the first order grounded in the

correspondence theory of truth ―according to which our thinking about reality is true if it agrees

with the way things really are or are not‖ (Adler, 1993, ¶11). It is the speculative dimension of

philosophy that addresses the descriptive mode of truth and it is expressed through the statements

of what ―is‖ and ―is not‖ in the world. For instance, we could observe and verify Aristotle‘s

theory of differentiation between animals. The prescriptive mode of truth is the philosophical

knowledge of the second order that deals with the ―ought‖ or ―ought not‖ of ethical and political

philosophy. Hence, it is the second dimension of philosophy that prescribes moral obligations or

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ethics (Adler, 1993). Prior to the 17th century, metaphysics had been accepted as first- order

philosophic knowledge, but then philosophers became divided in their views with some trying to

make philosophy scientific while others accepting the partial role of philosophy in clarifying or

correcting the conceptual errors of other disciplines (Simmons, 1992). Consequently, with the

separation of science from philosophy, during the 17th century, the prescriptive mode of truth

became the main prerogative of philosophy.

Influenced by David Hume‘s and Emmanuel Kant‘s demarcation between the conception

of science and philosophy, dominant thinking views of science focused on first order questions

and philosophy on second order questions (Adler, 1965;Simmons, 1992). To elaborate, a

scientist may ask, ―what is the prevalence of” or “what are the manifestations of

schizophrenia?‖ whereas a philosopher will ask, ―what is schizophrenia?‖ Data can be gathered,

categorized, and manipulated to answer the former (a first order question) but not the latter (a

second order question). However, a philosophical answer can be speculated through conceptual

analyses and assessment of the argument (Edwards, 1997). Nevertheless, many contemporary

philosophers including Adler, (1965) and Wallace (1983) apparently consider such demarcation

as a disservice to the power of philosophy in seeking knowledge about the world. In his famous

essay ―A method of its own‖ Adler, demonstrates how philosophy is a discipline in its own right

with a capability for answering first order questions. Simmons (1992) also presents a thorough

analysis about the interface of science and philosophy but also highlights the distinct role of

philosophy in knowledge development.

What Is Philosophical Thinking?

According to Kikuchi (2003), philosophizing or thinking philosophically refers to the act

of inquiry ―about the nature of that which exists and happens in the world and about what

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humans ought to seek and do; and then seeking answers to these questions through reflecting on

and analyzing our common-sense knowledge‖ (2003, p. 105). Adler (1978) described

commonsense knowledge as knowledge that is common to all people by virtue of their common

human experience in the world regardless of place or time, such as breathing, seeing, crying, and

laughing. Therefore commonsense knowledge is gained without investigative effort that is

needed for scientific inquiry, but by virtue of being awake in our daily life.

Philosophy involves asking general questions about nonmaterial aspects of life such as

good, bad, happy, or healthy and seeking to answer them by observation and analysis. To Adler

this is the essence of philosophy. Although based on common sense, philosophy asks and

answers questions in a contingent, logical, and rational manner (Adler, 1978; Kikuchi, 2003).

According to Simmons (1992), commonsense aggregates opinions or beliefs not obtained

critically or methodically. Similarly, reflection and continuity of questioning are important to

refine and sharpen our commonsense knowledge in order to develop ―the practice of insightful

questioning, the skills of intellectual discourse‖ (Hockey, 1990, P. 46).

Of What Use is Philosophy in Nursing?

Adler (1978), drawing on Aristotelian philosophy, asserted that ―philosophy is

everybody‘s business—but [it] is not in order to get more information about the world, society or

ourselves, . . . but . . . to help us to understand things we already know, understand them better

than we now understand them‖ (p. ix). Hockey (1990) believes that, philosophy helps a person to

develop a coherent world view that facilitates the conception of everyday experience, once we

adopt a philosophical attitude and way of thinking. Philosophy can help us to differentiate

between means and ends that, according to Aristotle, are important for purposeful life and

practical thinking (Adler). If the end is unknown, we can begin with questioning why we are

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doing what we are doing, until there is no further question of ‗why‘. To illustrate, most of us will

not deny that nurses need to have higher education, but we also need to know why this is so. The

answer could be to enhance nurses‘ knowledge. This in turn leads to more questions, such as

‗why should we enhance knowledge?‘ or what is knowledge? Possible answers to the former

question may be to improve patient care practices, or to gain autonomy, or to earn more money,

etc. Thus, obtaining higher education is merely a means to an end that must be determined using

philosophical thinking.

Similarly, philosophy can answer questions that science cannot (Kikuchi, 1992) or

address issues that are emerging with the advancement of science. For instance, with the

possibility of kidney transplants, some people are able to live longer. Nevertheless, rich people

exploit the poor by buying their kidneys or stealing banked kidneys. Considering some of these

negative consequences of organ transplant relative to the good inherent to the scientific

possibility of organ donation and receipt in society, one could imagine a worst-case scenario in

light of scientific progress towards cloning. Interestingly, science does not tell us whether we

ought or ought not to produce certain things because science is concerned with linear type

solutions. Nevertheless, philosophy addresses such issues in order to counterbalance the

undesired implications of scientific productions. Philosophy surpasses limitations of commonly

taught bioethical principlism to open up wider possibilities of thought and action for nursing

such as offered by relational ethics and inquiry. Since both, philosophy and nursing are

concerned about the world of human affairs, philosophical inquiry has special significance for

the discipline nursing (Adler, 1978; Bergum, 2004; Fry, 1992).

What Happens When Nurses Lack Philosophical Thinking?

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 Contemporary nursing practice is faced with multiple philosophical questions concerning

ontological, epistemological, and ethical areas of the discipline (Fry, 1992; Kikuchi, 1992;

Servimäki, 1999). According to Servimäki, although issues concerning the conception of nursing

reality, knowledge, and ethics are debated by nurse scholars in nursing journals, it is indeed

relevant to every practicing nurse because such issues are rooted in the way in which nursing

practice is organized and actualized. We can follow others and remain subservient if we might

perform actions without understanding or knowing the end goal of our actions. For instance, in

spite of considerable progress in nursing education and practice over the last 50 years, we still

endlessly debate about what nurses do differently than other health care providers or what is the

right level of pre-licensure education (e.g. diploma or baccalaureate degree) for entry to nursing

practice. These debates highlight the lack of identification of the nature, scope and end goal of

nursing, and cannot be resolved without philosophical attention.

Hockey (1990) posited that nurses lack the ability to philosophize because they are not

sufficiently stimulated by curiosity and wonder, but are ―accustomed to take things for granted

. . . [and] accept dutifully what is offered‖ (49). However, the extent to which curiosity and

wonder as an inner capacity of humans is actualized, depends on a variety of socioeconomic and

political factors in our environment (Adler, 1978; Kikuchi, 2003). Conroy (2001) asserted that

nursing education plays a role in socializing students that could lead to practices demanding

subservience rather than stimulating philosophical curiosity. This assertion sounds very true to

the status of nursing education in Pakisatn (Aziz, 2008; Lee & Saeed, 2001). The author personal

experience in nursing confirms Kikuchi‘s contentions that nurses‘ work environment, especially

in direct patient care, is not conducive to philosophical thinking and that often nurses are not

encouraged to think but rather to obey ‗orders‘ in conformity with authority. Street (1992) in her

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ethnographic study about nurses‘ work, presents numerous incidents of structural difficulties

which prohibit nurses from questioning patient care decisions, but rather devalue nursing

knowledge. If nurses aim to change this situation, we must allow time for reflection on our

experience and question why something is so. If encouraged to problem solve, we may find a

solution to change the situation. Structural difficulties may remain, but it is our thinking that can

help us to liberate ourselves and then help our clients (Kikuchi).

Why Do Nurses Need To Think Philosophically?

In view of the preceding discussion, philosophical thinking by nurses at the personal and

professional level is mandatory if we are to survive and progress as a valued discipline. Nurses

work with humans, their issues of existence, and matters of life and death. They face multiple

ethical issues that demand a human response. For example, patients safety issues demand that

nurses must be ―knowledgeable doers‖ (Holt and Clarke, 2000, P. 76). Nurses are involved in

making sensitive decisions, regardless of whether they work as clinicians, educators,

administrators, or researchers. Hence, they must be aware of what they do and why they do it.

Personal and professional values clarification helps to define the „what‟ and „why‟ in our

professional practice.

The difference between personal and professional values must be sorted out; any conflict

of interest whether intrapersonal or interpersonal, must be resolved to avoid negative

consequences to those whom nurses provide care. To illustrate, I present a situation (See Box 1)

from work experience as a nurse manager.

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 BOX –1 DIFFERENT PERCEPTIONS SURROUNDING MRS. X’S CARE

Mrs. X, 75 years of age, widow and completely dependent on her grand children was

admitted to CCU, after cardiopulmonary resuscitation in ER.. She was unconscious and unable to

breathe without aid due to severe pulmonary edema. She was manually ventilated before being

attached to a respirator/ ventilator once available. Mrs. X suffered from long standing health

problems including hypertension and diabetes that led to blindness and a unilateral knee level

amputation. She had multiple hospitalizations in the past. This was her third cardiac arrest.

While I was updating the physician about arrangements for a ventilator, a question arose

as to whether Mrs. X should be aggressively treated or provision be made for comfort care because

of the extent of her illness. When consulting with the family about what to do, the physician

mentioned that in his experience, Mrs. X chances of recovery were 70% if he could manage the

pulmonary edema. He also explained the high cost of care for Mr. X because of her need for

artificial ventilation. However, it was not mentioned how long she might remain on the ventilator or

what would be her quality of life while she is attached to the ventilator, nor further decisions that

would have to be taken regarding when to stop using the ventilator. Based on the provided

information, Mrs. X‟s family agreed to the ventilator. However, after two weeks on a ventilator,

Mrs. X had to be disconnected because her body gradually started disintegrating and she

was declared brain dead. Unfortunately, the family had to suffer emotionally as well as

financially.

Reflecting on Mrs. X‘s situation, I realize that although both, the physician and I had

scientific knowledge of pulmonary edema and the possibility of controlling it with drugs and

technology, we apparently differed in our philosophy of person and life. Primarily, the

physician‘s effort concentrated on the physical aspect of Mrs. X‘s lungs and restoration of their

10
function while my considerations were focused on the quality of life for the patient and her

family. I believed in dying with dignity rather than living in a vegetative state. Apparently, for

the physician, being alive was more important than the quality of life, or perhaps he either did

not want to be blamed for not doing everything possible or he needed a subject for his research to

determine the efficacy of a new drug. Although, a complete analysis of this situation is beyond

the scope of this paper, it is enough to demonstrate the effect of personal and professional

philosophy on those we serve.

Considering the above situation, it is clear that the effectiveness of scientific knowledge

and technological advancement may be misused or misdirected without philosophical or

reflective thinking and logical analysis. As Hockey (1990) stated, ―Wisdom cannot function

without knowledge, but the converse is not true‖ (46). Science provides facts and technology to

assist nurses to control or alter human physiological responses, but does not tell them what they

ought to do in such complex situations. Wallace (1983) considers that these situations are

comprised of multiple factors based on scientific facts and philosophical wisdom. To Wallace, it

is the composition of factual knowledge and its application in the specific context as part of

practical science that requires philosophy, whereas analysis is a common feature of all sciences.

Nevertheless, philosophy has a significant role in nursing because both deal with the humanistic

aspects of life (Adler, 1978; Fry, 1992; Phillips, 1992). Hence, philosophy serves a foundational

role not only in the creation but also in the application of knowledge in the provision of nursing

care, whether scientific, aesthetic, personal or ethical (Carper, 1978). Considering this, Silva

(1977) was right in saying ―ultimately, all nursing theory and research is derived from or leads to

philosophy‖ (p.61).

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 Finally, the extant knowledge of science can become obsolete with rapid advancements,

but philosophy is contemporary in nature (Adler, 1993). Thus philosophy seems to be necessary

for the development of the nursing profession and the discipline of nursing. Learning philosophy

means learning a process that could be useful for understanding information. If nurses learn to

challenge their own knowledge, arguments, and beliefs through thinking deeply about what their

practice comprises and how they put their thoughts into action, they will be able to identify the

phenomenon of nursing, its object and the scope of nursing. Otherwise it is impossible to

determine the discipline‘s philosophy, which is crucial for the survival of nursing as a discipline,

expressed by many nurse scholars (e.g. Donaldson and Crowley, 1978; Edwards, 1997; Jacobs,

2001; Johnson, 1968; Kikuchi, 1992; Mitchell, 1999; Salsberry, 1994).

Differences in Methods of Inquiry

From the above discussion it is evident that both, philosophy and science are two

important branches of learning that contribute to knowledge development. According to

Simmons (1992), abstractness is a condition for all knowledge. Hence, modes of inquiry into

knowledge can be differentiated based on its ability of abstractness from the matter.

Accordingly, philosophic inquiry is the most abstract and scientific inquiry is the less abstract

because the essence of science is investigative, where the essence of philosophy is common

experience that is not limited by space or time. Both are concerned with the matters of fact or

probable truth. Both strive for answers that are logical and offer theories or conclusions that are

subject to the test of truth whether empirical and logical. However, they differ distinctly in their

methods of seeking knowledge (Adler, 1965; Phenix, 1964). Method can be defined as a

technique or tool for gathering evidence, such as observation, reading, listening, questioning,

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reasoning or analyzing data. ―Each of these methods can be used in differing ways to produce

new views and alternative explanations of phenomena‖ (Bunting and Campbell, 1994, p. 76).

Science answers its questions by investigation. Adler (1965, p. 103) defined investigation

as a deliberate process of observations or method to answer a specific question, solve a problem,

test a theory or a priori hypothesis and draw conclusions or enhance knowledge. This knowledge

is generated on the basis of special experience or effort involving data collection pertinent to the

specific cause of investigation. Philosophy is non-investigative in a clinical sense, but it attains

probable truth about reality through the use of observation and logical reasoning. Unlike science,

it does not collect hard data for a special purpose, but it relies on reflective thinking for

―conceptual analysis and assessment of argument‖ (Edwards, 1997, p. 1091). Although

philosophy explains what is happening or has happened to facilitate our understanding, it does

not produce goods like science does that intervene or alter natural process or control our

environment. Unlike science, philosophy does not use sophisticated tools or gadgets to measure

things, perform testing and predict results. However, conclusions asserted by science and

philosophy can be verified, accepted or rejected based on common sense experience in the case

of philosophy and based on available investigative results in the case of science.

Philosophers are required to work alone and reflect upon phenomenon of the world based

on common sense knowledge and logical analysis, whereas scientists rely on others as the basis

of its interrogations (Giorgi, 2000). In spite of these differences, reasoning, imagination,

formation of concepts and theorising are common elements to both the method of inquiry (Adler,

1965; Christy, 1975).

Conclusion

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 Appropriate to the title and content of this article, let me conclude this paper by an

analogy. If the professional career of nurses is considered a purposeful journey on which to

embark, then we must know where we are going, what our destiny is, and why we have decided

to go there. All of this requires philosophical thinking. Once we know our purpose and end

goals, we must be know the means to reach the end, which route will take us there, what means

are available (e.g., walking, driving, flying, or sailing) or more efficient, the cost, comfort, and

the time involved. Science can answer some of these questions except that it does not tell us as

which option is more effective in the given circumstances. Philosophy can help us to think

clearly and coherently in and about nursing which in turn could help to do better nursing.

Recommendations

With the transition of nursing education in Pakistan from diploma to degree level

education, following steps are recommended to augment philosophical thinking in nurses. That:

 Nurses should consider the philosophical bases of their theory and practice in meeting the

health care needs of society.

 Nursing education should introduce the concept of philosophical inquiry to beginning

nursing students in the undergraduate program and continue to enhance philosophical

thinking through out their education.

 Equal importance should be placed on the philosophical and scientific method of inquiry

as warranted by the question and appropriate for the situation.

 Imagination and creativity should be considered as fundamental principles for all forms

of inquiry, including science and philosophy. The nature of classroom activities and

students‘ assessment must aim to develop and enhance reflective and analytical skills.

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  Nurse educators must create a learning environment that recognizes human potential and

facilitates critical thinking, which in turn will have a positive impact on our practice,

education, and scholarship.

Acknowledgement: I would like to thank and acknowledge Dr. Sherrill Conroy, Assistant
Professor University of Alberta for her comprehensive review of this article and her helpful
suggestions. A great deal of thanks must also go to my Professor, Dr. Joanne Olson, who taught
me to appreciate the role of philosophical thinking in nursing.

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