A service philosophy--who needs one? Part 2. A nursing service philosophy in practice.
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Humans↗
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[Loeb Center's nursing philosophy - a "perfect" nursing philosophy?].
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Decision Making↗
Does the philosophy of medicine exist?
There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine. Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the "philosophy of medicine", this is not enough to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. In order to constitute a field, an inquiry must be well-integrated with other cognate inquiries and disciplines, have an established canon of key books, textbooks, anthologies and articles, and a set of distinctive and defining problems. The philosophy of medicine as it currently exists fails to satisfy these criteria and, thus, fails to exist as a field of inquiry. The non-existence of the philosophy of medicine is unfortunate. Medicine and philosophy would both benefit from the development of the philosophy of medicine as a field. The philosophy of medicine is an essential foundation for bioethics, it should provide insights into some of the key problems of the philosophy of science such as the nature of explanation and theoretical evolution, and, ought help to shape the goals as well as the methods used in both experimentation and research in medicine and the health sciences.
Bioethics↗
Moving beyond: a generative philosophy of science.
Philosophies of science are perhaps the most covert yet significant forces influencing the direction of change within disciplines. Although the era of logical positivism has waned for many disciplines, newer philosophies may not be satisfactory, especially for the applied disciplines. This article describes an alternative philosophy of science with special significance for nursing. This philosophy was influenced by several of the major existing philosophies, but especially by the paradigmatic view espoused by Thomas Kuhn. The generative philosophy of science was named because of its focus on generating growth among the applied disciplines. Members of these disciplines study questions with social significance and human application. This article defines major concepts, describes relationships among concepts and discusses implications for the development of nursing science and the nursing discipline.
Philosophy↗
Establishing the moral basis of medicine: Edmund D. Pellegrino's philosophy of medicine.
Edmund D. Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes.
Beneficence↗
The need for teaching philosophy in medical education.
The dearth of philosophical contributions to medicine has recently been discussed in a series of articles in this journal. The present article focuses on physicians' lack of training in philosophy as a part of the explanation of the scarcity of works in philosophy of medicine. In section I I outline two philosophy courses which would be reasonable additions to the medical school curriculum required of all medical students. In section II I suggest two other philosophy courses as electives in a medical education. All four courses are in the fields of epistemology and metaphysics, and so will help others see the relevance to medicine of philosophical fields other than ethics.
Curriculum↗
The potential of medicine as a resource for philosophy.
In addition to the neglect of philosophy by medicine, emphasized in a recent editorial in this journal, there has been an equally important neglect of medicine by philosophy. Philosophy stands to gain from medicine in three respects: in materials, the conceptual difficulties arising in the practice of medicine being key data for philosophical enquiry; in methods, these data, through their problematic character, being ideally suited to the technique of linguistic analysis; and in results, the practical requirements of medicine placing a direct demand for progress on philosophical theory. The future of the relationship between philosophy and medicine depends on the development of a positive two-way trade between them.
Ethical Theory↗
Shaping the future through a philosophy of nursing.
Commitment to a philosophy of nursing requires input by all individual members of a division of nursing. The author describes the process of developing and introducing a new philosophy of nursing, including task force selection and preparation, review of potential strategies to develop a philosophy, details of the process used, and an introduction of the new philosophy to staff members.
Attitude of Health Personnel↗
Human development through occupation: a philosophy and conceptual model for practice, part 2.
The development of a philosophy of practice called "human development through occupation" is described in this paper. This philosophy was developed through study and identification of generic concepts in four major theoretical frameworks for occupational therapy described in a preceding article. The philosophy of practice proposes a view of Man, a view of human health, and a view of the profession. These theoretical and philosophical resources are then used to construct a conceptual model of the content and sequence of the occupational therapy practice process. It is believed that the four theoretical frameworks, philosophy of practice, and conceptual model detailed in these two papers can provide direction for general practitioners and specialists in service, education, and research. Examples of application are included, together with suggestions for further investigation.
Health↗
Philosophy and the DSM-III.
This report explores the interface between psychiatry and the DSM-III, arguing that philosophy and psychiatry are of value to one another. Three trends within philosophy are delineated--positivism, hermeneutics, and a synthetic position. These trends are applied to the DSM-III and to specific issues in psychiatric nosology such as the definition of mental disorder, the question of establishing boundaries between different psychiatric disorders, and the differentiation of organic and functional disorders. It is argued that while nosologists often think of themselves along positivist lines, and are often criticized by hermeneutic thinkers for just these assumptions, a synthetic view accounts best for how psychiatric science works. It is concluded that philosophy undergirds psychiatric nosology, while psychiatric nosology raises a series of philosophical questions.
Diagnosis, Differential↗
A corporate college of nursing and midwifery philosophy: a strategy for managing change.
This paper is an account of the process of identifying a college of nursing and midwifery corporate philosophy. This process represents one component of a change strategy for managing an amalgamation between three schools of nursing to form one college of nursing and midwifery. The paper is divided into four sections: Literature review, Methodological approach, Lessons learned and Managing change: a way forward. The literature review draws on what is described, in general education, as the school/college 'effectiveness literature'. This literature emphasises why the building of corporate norms is so important and that real change in the organization of a college cannot occur without the college redefining its commitments. A methodological approach embedded in grounded theory is described. This approach facilitated the discovery of colleagues' views from their perspective, and within their working context. It also enabled all the staff to take part in the process of identifying a corporate philosophy, which would subsequently underpin the college's educational policy and practice. This process was therefore conceptualised as an attempt to provide 'ownership' for a working corporate philosophy. In the final section it is suggested that many of the theories of change nurse and midwifery educators draw upon are conceptually and practically inadequate, as a basis for action in the socio-political climate of the 1990s. Effective approaches to the management of multiple changes calls for combining and balancing factors that do not apparently go together--in essence a dialectical approach to the management of change in nurse and midwifery education.
Data Collection↗
The medical philosophy of Francis Bacon (1561-1626).
Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the medically relevant study of mind. (He uses "mind" and "soul" as equivalent terms.) The healing of the body requires study of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to pathological changes. The aims of medicine should include not only the restoration of health but also the relief of suffering and they are not to be limited by putting aside a disease as incurable. To learn from treatment it must be fixed in its ordering with controlled and limited variation. Bacon has no separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism.
England↗
Doctoral programs in nursing: philosophy, curricula, and program requirements.
This study examined the philosophy, curricula, and program requirements of doctoral nursing programs in the United States. Forty-four doctoral nursing programs were solicited by mail and information about doctoral nursing programs was obtained. Of the programs, 31 offer the doctor of philosophy degree, 11 the doctor of nursing science degree, and 1 the doctor of education degree. Program philosophies could not be distinguished from one another. Eighteen doctoral programs offered advanced clinical courses and 22 programs focused on role preparation; 16 offered both clinical and role preparation. There was much variation in credit requirements, but the standard program was 60 credits in length, with 48 credits in nursing and 12 credits in cognates and electives. Approximately half the required credits focused on research. The similarity in the curricula of doctoral programs is striking. Discipline-specific values may be strong and account for the congruence in the types of curricula found in this study. Continued focus on research preparation, with varying degrees of emphasis on clinical or role development, is expected. The dominance of the doctoral degree as the terminal degree for nursing is likely to continue.
Curriculum↗
Concepts from eastern philosophy and Rogers' Science of Unitary Human Beings.
A brief outline of Buddhist thought is presented. Four concepts from early Indian philosophy which contributed to the development of the middle way consequence (Madhyamika Prasangika) school of Tibetan Buddhist philosophy are discussed. These are: action (karma), direct perception, emptiness, and dependent arising. An overview of Martha Rogers' science of unitary human beings is given, followed by a discussion of the concepts of energy field and integrality within her worldview. Buddhist concepts of action, direct valid perception, and emptiness are considered in relation to Rogers' notion of energy field; the concept of dependent arising is compared to Rogers' principle of integrality. It is proposed that Rogers' worldview includes areas of similarity with concepts used in Tibetan Buddhist philosophy.
Buddhism↗
Philosophy of medicine--from a medical perspective.
In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but is so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.
Ethics, Medical↗
A new philosophy of medical imaging.
In general, the traditional approach to medical imaging is based on the solution of the inverse problem of deducing the characteristics of tissues within the body from the received field resulting from probing radiation. Ambiguities and lack of complete data, and physical limitations such as diffraction, field non-uniformity and so on, prevent the image from being an exact representation of what would be seen if the imaged part of the patient were to be exposed to direct vision or drawn by an artist. Much more exact representation could be produced, however, if the philosophy of imaging were to be changed to involve the solution of the forward problem in which the received field is iteratively compared with that calculated to be produced by a computer-simulated model of the object from a knowledge base of anatomy, pathology, histology, physical properties of tissues etc. As a result of this converging process of comparison and iterative minimisation of the difference signal, a model of the object would be simulated consistent with the received field resulting from probing radiation as well as with all the relevant information form a knowledge base containing general knowledge and also including the personal records of the particular patient. Using such a model, any required cross-section or three-dimensional pictorial representation of the region of interest in the investigated object could be displayed in the form of a pictorial image. Thus the proposed philosophy would make medical imaging much less subjective and increase its information value, because inherently it includes all relevant biomedical data in the displayed image.
Diagnostic Imaging↗
Reconstructing nursing: a coronary care perspective of the primary nurse philosophy.
The philosophy underpinning the system of primary nursing and how it relates to the reconstruction of nursing merits consideration. This includes examination of the relationship of primary nursing to the concept and practice of caring: the movement of nursing to humanitarianism from pragmatism and the relationship to a process rather than a traditional system of nursing. Arguments concerning these topics are presented here and discussed in relation to the experiences and practice of a group of nurses in a Coronary Care Unit (CCU) before and after the introduction of a system of nursing based on the primary care philosophy.
Altruism↗
Some themes from the philosophy of psychiatry: a short review.
Some major themes in the philosophy of science are briefly reviewed, considering epistemological, ontological and ethical problems in modern psychiatry. A conception of realism at the ontological, empiricism at the methodological level and humanistic ethics is proposed. Meta-psychiatry is suggested as a theoretical discipline integrating clinical research methodology and philosophy of science.
Ethics, Medical↗