Defining the ‘what’ and ‘how’ of nursing

Philosophy has been part of nursing at least since the days of Florence Nightingale. Working independently or as part of a team, nurses care for the sick, the injured, the disabled and the dying; encourage the health of individuals, families and communities; and are leaders in healthcare management, research, policymaking and patient advocacy. Of all the healthcare professionals who attend to patients, the nurse is the constant in their care. It is this very uniqueness that makes a standard definition of nursing almost impossible.

“In nursing, you can’t be certain about what’s going to happen 10 minutes from now, let alone at the end of your shift,” says Miriam Bender, UCI associate professor of nursing. “We have a problem, literally, coming to terms with the ‘what’ and ‘how’ of our practice.”

To help solve that problem, she established the UCI Center for Nursing Philosophy in 2019. It provides a forum for discourse, discussion and scholarship about a profession constantly in a state of flux. It’s the first such academic center in the U.S., and Bender is the founding director.

“The idea of philosophy and nursing is because we deal in the moment, we deal with difference, we deal with the unique – and this is something that traditional knowledge structures and processes don’t really fit well,” she says. “We deal with patients who are unstable, hospital systems that are inadequately or differently resourced, and so we do things within that complexity, reliably and consistently. What we’ve noticed is that philosophy provides a context for us to talk through our ‘what’ and ‘how’ of nursing in ways that are more flexible and allow a little bit more freedom than the established framework of knowledge generation.”

Discourse, discussion and scholarship

The Zoom lectures and reading groups hosted by the Center for Nursing Philosophy encompass a wide range of topics, from Jainism to racism, and have generated great interest and participation from colleagues across the U.S. and around the world. An annual fellowship supporting promising nursing science graduate students and new nursing faculty members continues the development and dissemination of scholarship in nursing philosophy.

The inaugural CNP Fellow, UCI nursing science graduate student Zahra Sharifiheris, conducted a comprehensive assessment of the concept of nursing philosophy in the existing literature. She presented her findings at the virtual 2020 International Philosophy of Nursing Society Conference.

“Nursing suffered from not having an agreed source of knowledge, so it’s often borrowed ideas and sources of knowledge from other proficient fields, like medical humanities or philosophy,” Sharifiheris says. “The problem exists because nursing has a unique perspective toward patients’ health. We don’t only look at what we can test and observe and then apply a specific framework and rule. A single standard doesn’t work because people have different backgrounds and cultures. We need flexibility to create new, reliable nursing knowledge.”

This year’s CNP Fellow is Jess Dillard-Wright, an assistant professor of nursing at Augusta University in Georgia. The focus of her scholarship is radical ethics. “The goal is to find answers to questions that offer a different version of what a nurse looks like other than the traditional ‘lady with the lamp.’ I really love to connect with folks outside the field and invite ways to evaluate how nursing is situated in society so that we think about health and well-being as a function of community, rather than so narrowly individually focused,” she says.

Bringing philosophy into the real world

Josh Dolin is a philosophy graduate student in UCI’s School of Humanities. He and Bender – along with idea originator Mark Risjord, professor of philosophy at Emory University – are currently developing a pilot course for nursing science graduate students and junior nursing faculty who are interested in the intersection of philosophy and nursing scholarship.

“Philosophers argue carefully and seek conceptual clarity. They have technical tools, mostly logic and a number of concepts and distinctions, that can shed light on just about any issue,” Dolin says. “Some philosophers are interested in applying their technical tools to issues concerning public affairs and professional roles, which is something I’ve always wanted to do. I’m always looking for opportunities to bring philosophy into the real world, as it were, and I thought getting involved in the UCI Center for Nursing Philosophy was one such opportunity.”

Bender believes philosophy provides the flexible framework that enables nurses to work through problems and find solutions that traditional approaches do not. “A lot of times, we use a more philosophical, dialectical discourse,” she says. “For example, the COVID pandemic is a fast-paced, dynamic situation. Conventional ways of doing research take too long to generate the necessary knowledge for action, and by the time you’ve done that, the world has moved on and things are different. Welcome to nursing.”

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