Philosophizing in skilled nursing care: Must or nice?

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Open Journal of Nursing, 2013, 3, 499-502 OJN

http://dx.doi.org/10.4236/ojn.2013.37068 Published Online November 2013 (http://www.scirp.org/journal/ojn/)

Philosophizing in skilled nursing care: Must or nice?

Fatemeh Khoshnavay Fomani1, Mohammad Ali Cheraghi1, Yahya Ghaedi2,

Rahmatollah Kharazmi Rahimabadi3

1School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2Department of Educational philosophy, Kharazmi University, Tehran, Iran

3Department of Education, Farhangian University, Imam Ali (PBUH) Branch, Rasht, Iran

Email: [email protected], [email protected]

Received 31 July 213; revised 5 September 2013; accepted 26 September 2013

Copyright © 2013 Fatemeh Khoshnavay Fomani et al. This is an open access article distributed under the Creative Commons Attri-

bution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly

cited.

ABSTRACT

To become a professional nurse requires that nurses

learn to think in a right way. Thinker nurses strive to

be clear, accurate, logical, complete, precise and faire

in their practice and manner. In other words, a

thinker nurse is a philosopher who has the ability of

reasoning, critical and reflective thinking. In many

investigations, the role of critical or reflective think-

ing is explored, but in this review article, we are try-

ing to introduce a comprehensive concept that in-

volves all these elements of thinking skills. It is philo-

sophizing.

Keywords: Philosophizing; Nursing Care; Thinking

Skills

1. INTRODUCTION

“Nursing encompasses autonomous and collaborative

care of individuals of all ages, families, groups and

communities, sick or well and in all settings. Nursing

includes the promotion of health, prevention of illness,

and the care of ill, disabled and dying people. Advocacy,

promotion of a safe environment, research, participation

in shaping health policy and in patient and health sys-

tems management, and education are also key nursing

role” [1]. If ever, there were a key component in nursing

practice and education, it would be thinking [2,3]. For

example, in clinical practice, the nurse engages in think-

ing and doing simultaneously [3]. Thinking is embedded

in nursing care and quality of care is regarded as quality

of thinking. Han (2007) stated that even in high techno-

logical care systems, we cannot disregard the role of

thinking. Although in modern health care systems, much

technological development has taken place in caring

context, but quality of care is not depend on techno-

logical developments solely. Albeit technology provides

improvements in health care, but undoubtedly, effective

use of thinking strategies is essential to provide a quail-

fied care [3].

2. SKILLED NURSING AND

REFLECTIVE THINKING

Substantiation of care goals is based on knowledge and

skills combined. In their qualitative study, Buller and

Butterworth (2001) investigated the elements of skilled

nursing and found that skilled nursing practice involves

four domains: doing the job, being professional, relating

& communicating and managing & facilitating [4]. Con-

sidering these four domains, it is evident that a skilled

nurse is a thinker nurse because, the cornerstone of pro-

viding care, being a professional nurse, making relation-

ship with patients and families or other members of pro-

fession and being a skilled manager, is thinking skills

such as reflection or critical thinking. Shiau and Chen

(2008) dissected reflection in medical care and enounced,

while health professionals, are expressing care, they need

to understand that “the process requires looking inward

at one’s own selves, then outward at the world around

them, and then back in again” [5]. It means reflection.

According John (1997) we use reflection on practice, in

order to interpretation of process or experience. In Kem-

ber et al., (2000) definition, process of reflective practice,

is a thoughtful practice into a potential learning situation.

Hall (1995) introduced three types of reflection: reflec-

tion before action, reflection in action and reflection on

action. Reflection as a mental process, applied to gain a

better understanding of ideas that are relatively compli-

cated [6]. By reflection, the nurse, can verify experiences

or situations and analyze them. Also it is an opportunity

to challenge values, beliefs and assumptions [5].

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3. SKILLED NURSING AND CRITICAL

THINKING

It is expected that a skilled nurse be adorned to reflective

maturity because this competency is preliminary of hu-

manistic care. Humanistic care is something more than

medical care. It is a mainstream to get holistic care [5].

In our perspective, one way to get the competency of

reflective maturity is critical thinking. According to Paull

and Scriven (1987), critical thinking is process of ana-

lyzing, synthesizing and/or evaluating information. This

is a worthy and fundamental concept in nursing curricula,

practice and clinical decision-making because of its di-

rect affects in patient outcomes. In context of nursing

care, critical thinking is used to analyze patients

̛situation,

consider patients’ circumstances, needs and feeling, as-

say nursing measures and recognize the appropriate time

to seek alternative treatments. According to Staib (2003),

critical thinker nurses, apply standards and seek informa-

tion in their practice. They have logical reasoning skill

and able to predict events or outcomes also they are ca-

pable to knowledge transformation [7,8]. Lewenson &

Truglio-Londriga (2008) acknowledged that health care

arena is high complex and dynamic while many factors

such as history, legal and ethical issues, spirituality, cul-

ture, media, economic status and health care policies,

impress this circumstance [5]. It is clear that, in this bat-

tlefield, only a thinker nurse can overcomes the barriers

and provides an eligible care.

4. HOLISTIC CARE IN SKILLED

NURSING AND THINKING

In nursing discipline, the most preferred caring, is holis-

tic care. This claim can be support by McEvoy & Duffy

(2008) explanation: “nursing is indeed holistic in nature”

[9]. In the philosophy of holistic health care, people are

something more than body and mind. Human is com-

posed of mind, body and soul integrated into a whole

with inseparable parts [9,10]. The whole is in dynamic

interaction within itself and universe and well-being is

the sequel of balance and harmony in all parts. Maybe

Nightingale was the first nursing theorist that mentioned

holistic care. When she (1996) stated one of the nurse’s

roles is putting the patient “in best condition for nature to

act upon him”, and for 100 years, the nursing, conform

her guidance, the holistic health care in nursing practice,

implicitly acknowledged. It is accepted that the nurse

role is to help people get well, stay well and even have a

peaceful death. It is Oppressive that, some nurses often

failed to recognize the worthiness of their care [10].

Having a holistic point of view and doing this way, is

embedded with thinking. Thinking process helps the

nurse to understand the whole of clients or patients.

Thinking is a magic wand for making harmonies or di-

agnosing disharmonies and fixing that.

5. HEALTH PROMOTION & WELLNESS

IN SKILLED NURSING AND

THINKING

Not only it is expected that nurses will be good thinker,

but the community’s expectations from nurses, is receiv-

ing services in the field of mind and thinking too. This

expectancy is rooted in the nurses’ roles in health promo-

tion. For instance, mental health, as aspect of human

health, is one of nurse’s roles that is related to mind and

thinking process. In the international classification of

health workers (2010), nurses as “health workers”, pro-

vide treatment, support and care services for people who

are in need of nursing care due to the effects of ageing,

injury, illness or other physical or mental impairment, or

potential risks to health, according to the practice and

standards of modern nursing” [11]. In this classification,

providing care and treatment to individuals with mental

problems is mentioned. Moreover health promotion and

the desire to promote healthy communities is a focus in

nursing discipline. These ideal goals are supported in

nursing programs and curriculum as well as community

activism by individuals and groups of nurses [12]. In

other words, one of nursing mission is promoting well-

ness in individual and community levels. Moore & Hu-

erena (2005) and World Health Organization (2006)

mentioned that the core of health concept is wellness.

Carlson (2003) believes, wellness is based on promotion

and maintenance of health and capacities for living rather

than on healing of poor health and solving problems [13].

According to the Mickinley Health Centre, University of

Illinois, wellness is “a state of optimal well-being that is

oriented toward maximizing an individual’s potential.

This is a life-long process of moving towards enhancing

physical, intellectual, emotional, social, spiritual and

environmental well-being” [14]. When we talk about

wellness promotion in nursing practice, we are confirm-

ing that a skilled nurse as a thinker health worker, is re-

sponsible to promoting all aspects of wellness in all lev-

els of individuals, families and communities. Wellness,

as mentioned above, is a process with a progressive es-

sence to catch well being. How we can promote our

wellness, without good thinking strategies? If we are

nurse or patient, we must rely on our thinking skills to

make our life better and get to our maximize potentials.

6. PHILOSOPHIZING IN SKILLED

NURSING

For many years, we are training and educating our nurs-

ing students, to learn the way of right thinking. Not only

in nursing education, but in any discipline, learning to be

a good thinker, is focused and counts a worthy aim [15].

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F. K. FOMANI et al. / Open Journal of Nursing 3 (2013) 7-10 501

In modern academic educational systems, the ultimate

goal is to produce individuals more than technicians who

do any routine tasks in their profession or job. Graduates

must possess creativity, imagination, sensitivity, and

communication skills as well as proficiency and ability

to analyze and synthesize situations. In medical educa-

tion, goal oriented approaches, based on multidiscipli-

nary integration, has the potential to prepare the individ-

ual to response to rapid changes in society and therefore,

the professional members, will be more proficient in

their roles and tasks [16]. Although many theorists try to

find a feasible way to catch this educational systems de-

sire, but historically, philosophy has been the ensign, in

this battlefield. Between many models and methods try-

ing to teach students, the right way of thinking, Matthew

Lipman model (2003) was an innovative, walkaway and

philosophical model that stand out. “Philosophy Goes to

School” and the followed book titled “Philosophy in

Classroom” as well as stories and exercise books for

children and adolescents, was parts of Lipman effort in

this way. He tried to explain how we can integrate phi-

losophy examination to education [15]. In fact, Lipman

as one of the most influential person in education intro-

duced a new paradigm in this area and paved roads to

reach their destination that has always been the desire of

all actors in the field of education. His model adjusts to

fast changing societies that are moving towards global-

ization and to the citizens who increasingly struggle to

make sense of the world and of their lives [17]. This part

of Lipman model, is exactly applicable to today’s nurs-

ing world because of the changing nature of health care

and globalization in nursing profession. Lipman believed

that skilled individuals thinker, are those have three skills

thinking: critical, creative and caring thinking [15]. Thus

Lipman model can be an integrated framework that con-

tains all core elements of thinking skills has been intro-

duced in other models. There are some frameworks de-

signed by theorists that introduced thinking skills, but the

most widely accepted is Bloom’s Taxonomy (1956) [18].

In lipman’s model, creative and critical thinking is dealt

with cognitive domain of Bloom’s Taxonomy and caring

thinking is mostly related to affective domain of this

taxonomy. Caring thinking is just like a formula bringing

critical and creative thinking together. Through caring

thinking, we convert our felling to our choices, decisions

and even judgments. Caring thinking is the philosophical

verification and justification of critical and creative

thinking [15]. Philosophizing is “to reason in the manner

of a philosopher” [19]. Therefore according to lipman

philosophical model, when we talk about philosophizing,

in fact we are referring to critical, creative and caring

thinking skills together. And a philosophizer, thus, who

has the ability of analyzing, synthetizing, logical reason-

ing, predicting, thinking about our and other’s ideas or

emotions, verifying situations and challenging values and

beliefs.

7. CONCLUSION

Philosophizing is a comprehensive concept that involves

all elements of thinking skills. Nursing as a practical

discipline, needs “practical nurses” and practical nurses

are able to “practical think”. It might seem that a practi-

cal thinker constantly eliminates thinking or reflection

from the material world equation, but the material world

and the world of thinking are and shall remain in an in-

separable symbolic [20]. Especially in nursing care con-

text, the nurse deals with a human as a patient or client.

Going toward professionalism in nursing and providing

holistic care for patients, or promoting health care and

wellness in individual and society levels, it needs to ap-

ply good thinking strategies. Philosophizing is a cogni-

tive competency that integrated all thinking skills and

deserved to be included in education and nursing prac-

tice.

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