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Philosophy of Nursing Nancy Hudson, Teresa Millwater, M. Megan Vasseur Northern Kentucky University Highland Heights, KY DNP 800

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Philosophy: Definition and Importance A philosophy defines the core components that delineate the standards of an individual or a profession; detailing what beliefs, values, and attitudes guide, direct or motivate decisions made by that individual or profession. Philosophies articulate, for the population at large, the way in which a group or individual communicates the elements that shape their views. The philosophy of a profession should reflect three basic components: metaphysics, epistemology, and axiology. Metaphysics is a systematic inquiry about the nature of reality. Epistemology is the justification of belief. Finally, axiology seeks to describe what one values (Keating, 2006). Philosophies are dynamic in that they are shaped by growth and experience but, the core of nursing philosophy centers on care, compassion and fundamental human needs (Johnstone, 2011). Dating back to Florence Nightingale, nursing philosophies continue to evolve to support how we practice today. Nursing philosophy is the motivation behind why and how we conduct our daily practice. Former experiences and educational levels affect personal philosophies and often change over the years. Differing patient care settings may have varied philosophies as determined through patient populations. Facilities often create their own practice philosophies to ensure nursing care is consistent (Ondrejka & Barnard, 2011). Accepted Philosophies The dynamic nature of nursing philosophy asserts that each new philosophy or theory is based in fundamentally established principles. Development of a philosophy or theory is an attempt to fill the gaps that exist due to the complex nature of humans and the human experience (Green, 2009). "It is suggested that each new theory of nursing is founded, at least in part, on the need to account for attributes of the person missing from prior nursing theories" (Green, 2009, Abstract section). Practice philosophies often combine multiple theories to support practice. For

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example, different aspects of theories by Florence Nightingale, Peplau, and Leininger may be combined into a single philosophy specific to nursing practice areas. Nursing philosophies have evolved over the years, examples include: a) Heideggers Hermeneutic Philosophy (1962), b) Clark's Nature of the Human Person (1993), c) Van Manen (1990) Caring Philosophy, The Ethics of Care, Ethics of Justice Theories, d) Patricia Benner's From Novice to Expert, d) Peplau's Interpersonal Relations Model, e) Rogers's Unitary Human Being, f) Orem's Self- Care Model, g) Henderson's The Nature of Nursing, h) King's Goal Attainment Theory, i) Neuman's Health Care Systems Model, j) Roy's Adaptation Model, and k) Watson's Philosophy and Science of Nursing (Nursing theorists, 2011). These theories and philosophies continue to provide representations of the profession and identify unique properties comprising the human experience. Further, they identify responsibilities nurses have in acknowledging diversity, providing individualized care, and offering assistance with the utmost care, compassion, and competence. Department of Nursing/DNP Philosophies Development of DNP philosophies should have considerations for the levels of nursing practice, patient care specialties, environmental aspects and treatment facility expectations. As nursing care continues to evolve, philosophies may change to reflect evolution in practice. Doctors of nursing practice provide insight for changes in daily nursing care through use of evidence-based practice. Providing varying philosophical views and traditions for practitioner consideration is what nursing philosophy does best. Participation in debate over different views of nursing practice is how understanding of these views begins (Sellman, 2009). With changes in healthcare, as well as nursing education, comes an evolution in nursing philosophy. One such addition is the Doctor of Nursing Practice (DNP) degree and the DNP

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philosophy. During a search for specific DNP philosophies, no such DNP specific statements were identified. Nursing schools identified a philosophy for their individual programs but curiously, no results were discovered for the DNP nurse with a general Google search or searches on CINAHL, and Medline. When performing a search on Northern Kentucky University's website, again no specific DNP philosophy was identified separate from the Department of Nursing philosophy. However, access to the DNP handbook on blackboard does have a section on doctoral outcomes and philosophy. According to the DNP handbook at Northern Kentucky University (2011), The Doctoral programs in the Department of Advanced Nursing Studies are consistent with the philosophy of the Bachelor and Master's programs. They share a conceptual framework that includes the following concepts: communication, critical thinking, caring, professionalism, role competency, cultural competency, and research. The Doctoral programs prepare the graduate to be a steward of the discipline. The doctoral education 1) starts from the students experience 2) develops through experiences that are experiential and transformational and 3) culminates in the graduate taking on the role of nursing expert. Components of doctoral learning include opportunities for 1) formation of a deep understanding of the graduate's place in the history and cultures of nursing, 2) development of skills of inquiry, 3) generation of new nursing knowledge and 4) alignment with faculty in strong mentoring relationships. Doctoral education takes place within nursing frameworks and intersect with the sciences, arts, technology, health policy, and economics. Learning takes place in a scholarly community grounded in standards for rigor, the nursing imperative of caring and a plurality of voice. (p.5)

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Another approach for developing DNP philosophies is through use of the American Association of Colleges of Nursing DNP Essentials. These criteria provide the foundation of DNP qualities and responsibilities. Concepts included within the essentials include: a) use of science to provide the conceptual basis of nursing, b) organizational leadership to improve patient outcomes, c) research and its application to practice, d) use of information technology to improve healthcare, e) development and implementation of healthcare policy, e) collaboration with the entire healthcare team to improve patient outcomes, f) involvement in population health, and g) advanced knowledge in clinical practice (AACN, 2006). Understanding these foundational concepts will assist DNPs in formulating their philosophies for clinical practice. Strengths/Weaknesses of Current Nursing/DNP Philosophies A strength of current nursing philosophies is they continue to evolve. With changes in healthcare and evolution of nurses in advanced practice roles, philosophies should be shaped by growth, experience, and professional development. They should be both general and specific in nature and should be developed to reflect type of practice, type of setting, or type of educational program. Therefore, a weakness identified while searching for philosophies specific to DNP programs and philosophies is difficulty in finding the basic concepts within the literature. Many programs did not differentiate DNP program philosophy from other degrees. Universal and Divergent Philosophy Concepts Universal concepts include caring, competence, ethical and moral fortitude, responsibilities of the nurse to the individual; their return to and maintenance of wellness. Elsted (2009) writes When life processes are affected by sickness, infirmity, medical interventions or mental suffering, individuals need competent help to live and live as well as possible (Elsted, 2009, abstract section). Some would argue changes in the complex nature of human beings are

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resulting in changes in philosophies. Green (2009) asserts merging theories would be the appropriate course, while Johnstone (2010) argues justice is the missing element. In her study, Nursing and Justice as a basic human need, she writes ..the idea that justice is a basic human need ..warrants recognition as a core element in representative ideas about nursing (Johnstone, 2010, abstract section). Comprehensive Philosophies As a group, our comprehensive views of nursing philosophy include use of science in daily practice, patient-centric care, focusing on national patient safety goals to prevent harm to patients, incorporation of research and evidence-based practice, communication, and promotion of ongoing education. Identification of nursing philosophers who address these components while incorporating personal insight gained through experiences will comprise a comprehensive philosophy of nursing. The DNP comprehensive philosophy expands view points through application of research to improve nursing practice. Development of policies, clinical practice guidelines, and representation at leadership levels assists in the expansion of nursing roles in providing safe patient care with optimal outcomes.

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References AACN (2006). The essentials of doctoral education for advanced practice nursing. AACN Task Force on the Practice Doctorate in Nursing, 1-28. Elsted, I., and Torjuul, K. (2009). The issue of life: Aristotle in nursing perspective. Nursing Philosophy 10, pp. 275-286. Green, C. (2009). A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy, 10, pp. 263-274. Johnstone, M. J. (2011). Nursing and justice as a basic human need. Nursing Philosophy, 12, pp. 34-44. Keating, S.B. (2006). Curriculum development and evaluation in nursing. Lippincott Williams Wilkins: Philadelphia, PA. Northern Kentucky University Doctor of Nursing Program Student Handbook (2011). Retrieved on September 22, 2012 from https://learnonline.nku.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_3_1&url=/w ebapps/blackboard/execute/launcher?type=Course&id=_114267_1&url= Nursing Theorists (2011). Retrieved September 23, 2012 from www.currentnursing.com/nursing_theory Ondrejka, D., & Barnard, D. (2011). Implementing a professional nursing practice philosophy and model: Using affective methods to address resistance. Creative Nursing, 17(3), 139147. Sellman, D. (2009). Ten years of nursing philosophy. Nursing Philosophy, 10, 229-230.