Philosophy of Nursing

Universality and singularity have given us a clearer understanding of

what nursing is and what makes nursing unique. In this sense,
universality and singularity have illuminated nursing. Universality and
singularity have allowed us to achieve new insights that illuminate the
concept of nursing in depth. Nursing is interested in that which is
repeatable and shareable, the universals. Yet nursing is interested in
the uniqueness of persons and eventsespecially events that change the
lives of persons.
Though persons and events are unique, persons and events are a
combination of universality and singularity. Hence a very important
uniqueness about nursing is the way in which nurses balance the
complexity of the shareables with the unexpected uniqueness of
persons and events.
In fact, what we, the co-authors, have choose to call a "nursing event"
is a unique occasion, nonrepeatable and nonshareable, having a
specific address in time and space, between two unique persons,
patient and nurse, brought together by the universals of health and
illness.
But the way that nurses acquire, develop, and use technological skills
is a combination again of universality and singularity. There are
standards (universals) in the development and the use of technology
(universals), yet each nurse and each occasion is unique in the
application of the technology to unique persons. The practicing nurse
assesses a unique situation and improvises as necessary, perhaps
combining several skills to achieve one objective. Hence, creativity in
nursing is a combination of universality and singularity.
Assessing a unique individual patient in a unique situation requires
great skill and great knowledge on the part of the nurse. He must be
sensitive to a changing situation, comfortable with complexity and
sometimes even chaos, and have the wisdom and the delicacy to
balance the ever changing mix of universals and individuals.
But how is this wisdom obtained? Nursing wisdom is obtained from
several different sources. The nurse uses science, physical and human,
technology, nonscientific knowledge, intuition, and past nursing
experience, both individual and collective. Though we have already
examined many of these sources of wisdom, we have yet to address
the complexi
ties of intuition as it occurs in nursing. Nursing knowledge combines
universality and singularity, and hence we need to examine the
grounds of singularity more fully. In addition we also need to look at
the nursing event once again, for further illumination of the concept of
nursing. But the nursing event requires that we look at the nature of
persons as communities of experiencing entities. That persons are
communities of experiencing entities means that nursing views the
body as within the self and not the self as within the body. In order to
understand both the person as a whole and his or her subordinate
experiencing entities, it is necessary to revisit the distinction between
behavior, conduct, and action, and why it is essential to view each
nursing event as an opportunity for the patient to make the transition
from behavior to action. These topics were addressed partially in
earlier chapters, but will be developed more fully in this chapter.
Exposition of Nursing Based on Universality and Singularity
The reader will notice that the title of this section is "an exposition of
nursing." We have intentionally avoided the use of the phrase
"definition of nursing." We have chosen to expound rather than define
nursing, because the writing of this book has strengthened our
conviction that no simple definition of nursing is possible. The reason
that no simple definition of nursing is possible lies in the elusiveness
of the concept of nursing and the complexity of nursing itself. Nursing
is complex because the practicing nurse is concerned with persons in
all of their complexity.
Persons are a combination of shareable universals and yet are unique.
But adding to the complexity of persons, the imaginary discussions
with the philosophers called our attention to the fact that persons also
straddle more than one worldPlato's intelligible and sensible worlds,
Kant's noumenal and phenomenal worlds, Whitehead's
Everlastingness and the temporal world, the world of the mystic's One
and the everyday world.
Since nursing chooses to remain focused on persons, nursing chooses
to straddle more than one world. Nursing requires that the individual
nurse be as nearly a renaissance person as possible, in order to
understand and appreciate the uniqueness of each individual person
and event.
Persons combine universality and singularity. On the one hand there is
a long list, if not an infinitely long list, of universals that are true of
any individual person. But on the other hand the uniqueness of each
individual person is guaranteed by multiple grounds of singularity
(discussed later in this chapter). Although practicing nurses are
interested in what is shareable by persons, and in fact nursing research
is often directed toward discovering the shareables (qualitative and
quantitative) in persons and nursing events, nurses respect the
uniqueness of persons and the uniqueness of the events that are parts
of the lives of persons. Appreciating the uniqueness of events, the
nurse engaged in a nursing event with a patient is aware of how each
event is connected to the openness or closedness of future possibilities
for the patient and also for the nurse. And though nursing employs
universals to develop skills and uses technology important to the
health of the individual person, nursing never allows itself to stray too
far away from its home, lured by the glitter and power of technology.
Nursing's home is beside unique persons, and nursing draws its
vitality from unique persons and events.
Perhaps there is a parallel to be found here in Grimm's fairy tale of
Hansel and Gretel. Like Hansel and Gretel who let themselves be
temporarily lured away from their home by the appeal of
confectionary delights, nurses too can be temporarily lured away from
home by the appeal of the power of technology. Following the
confectionary delights, Hansel and Gretel almost ended up in the
witch's oven. If nursing strays too far from its home beside persons, it
too may disappear. But the story of Hansel and Gretel had a happy
ending. They escaped the witch and the lure of the confectionary
delights and found their way home again. But they took pieces of the
confectionary delights home with them (Grimm and Grimm 1812, p.
22). Nursing also needs to follow the example of Hansel and Gretel.
Nursing saves itself from destruction by returning home to the patient,
but with the "confections" of technology that are useful for the good
care and can be shared with the patient. Nursing retains its vitality
byreturning home. Nursing corrects its fascination with new
technologies needed for the skills of caring (universality) with its
focus on the unique individual person and event (singularity). Good
nursing requires balancing these two factors, universality and
singularity, in the nurse, in the patient, and in the nursing event.
The coming together of two unique persons with their unique pasts,
patient and nurse, in a unique nursing event with its unique past, is at
least partially the result of the general universals, health and illness. It
is the presence or absence of these two universals that prompts the
occurrence of the nursing event. The skills and knowledge that the
nurse brings to the nursing event is a complex mixture of universals
drawn from the sciences, everyday nonscientific knowledge, and the
past experiences of both himself and other nurses. The way that the
nurse sees through the veil of universals to grasp the uniqueness of the
person of the patient and the uniqueness of the nursing event is
through intuition.