Journal of Advanced Nursing, 1997, 25, 1089–1093
What is philosophy of nursing?
Steven D. Edwards RMN BA (Hons) M Phil PhD
University College Fellow, Centre for Philosophy and Health Care,
University College Swansea, Swansea SA2 8PP, Wales
Accepted for publication 15 May 1996
Journal of Advanced Nursing 25, 1089–1093
What is philosophy of nursing?
This paper tries to describe the nature of the subject-area known as philosophy
of nursing. It is suggested that attempts to offer such a description are beset with
difficulties surrounding both nurses’ and philosophers’ conception of
philosophy. Nonetheless, this paper does seek to offer a description of what
philosophy amounts to. Schrock’s suggestion that philosophy can be
characterised partly by its methods and the distinctive nature of its questions is
tentatively endorsed. Her proposal is buttressed with an account of Carnap’s
distinction between internal and external questions. It is shown that this
distinction helps to identify philosophical questions. Further, an attempt is
made to show the importance of the distinction between a philosophy of
nursing and philosophy of nursing. It is concluded that philosophy involves
conceptual analysis and assessment of argument, concern with highly general
metaphysical and epistemological questions, and that such questions can be
regarded as ‘external’ questions. It is then shown how these three elements of
philosophy also characterise philosophy of nursing.
EDWA RDS S.D. (1997)
I NTRODUCTI ON
It is common to point out that nursing is essentially a
practice discipline (Sarvimaki 1995). This is not to deny
that theorising about nursing occurs. But any nursing
theory which is developed will be evaluated in terms of
its implications for nursing practice. These points are
uncontroversial. But it follows from them that philosophy
of nursing must, therefore, be philosophy of a practice
discipline. It follows from this that philosophy of nursing,
if it exists, is a branch of applied philosophy. Some philosophers appear sceptical regarding the legitimacy of applied
philosophy (Warnock 1992). So if there is such a subjectarea as philosophy of nursing, such sceptical philosophers
will need some persuasion. The following paper is
intended to provide some such persuasion by articulating
a plausible description of philosophy of nursing.
Nurse theorists seem not to need convincing of the legitimacy of the idea of philosophy of nursing. But this may
well be due to uncertainty or confusion regarding what
philosophy is. This paper is addressed primarily to nurse
theorists whether or not they are convinced of the coherence of philosophy of nursing. It is hoped that the paper
will provide a clear articulation of philosophy of nursing.
© 1997 Blackwell Science Ltd
This will at least have the benefit of facilitating informed
debate as to the ultimate coherence of the subject. Given
an adequate articulation of philosophy of nursing at least
those for and against it will have a clearer idea of what it
is they are arguing about; or so it is hoped.
WHAT IS PHILOSOPHY? NURSES SPEAK
There seems to be some disagreement amongst nurse theorists regarding what is meant by the term philosophy.
Schrock (1981a) points out that philosophy of nursing is
often mistakenly construed to refer to an ideology of nursing. She construes ideology, roughly, as a set of unexamined presuppositions which influence attitudes and
practices. Schrock offers the examples of views such as
‘nurses are born, not made. [And] nursing is an art based
on common sense’ (Schrock 1981a p. 11). Weidenbach may
commit the mistake which Schrock warns against.
Apparently, for her
Philosophy [is] an attitude toward life and reality that evolves
from each nurse’s beliefs...
(Marriner-Tomey 1994 p. 89)
If I understand Schrock, her warning is that it is not
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S.D. Edwards
obviously the case that philosophy involves the proposal
of any definite claims. Rather, she suggests that philosophy
might best be characterised in terms of its methods and its
problems (Schrock 1981b). As may be seen, the claims
made in the present paper lend broad support to Schrock’s
suggestion.
More recently, Simmons has offered the following
definition of philosophy
By philosophy, I mean knowledge of first causes or of the highest
principles of things in so far as these causes or things belong to
the natural, as opposed to the supernatural, order
(Simmons 1992 p. 112)
She goes on to add that this, more properly, should be
understood only as a definition of metaphysics.
Simmons offers no reference in support of her definition,
and as it stands it seems vulnerable to some quite serious
objections. First, sceptical philosophers doubt that it is
possible to obtain any knowledge of anything (Ayer 1956).
So a (philosophical?) claim to the effect that one could not
be certain of the existence of anything would not count as
philosophy by Simmons’ criterion. Hence she seems
wrong to restrict philosophy to knowledge of first causes,
or indeed, to knowledge of anything else. Second, her
definition seems to omit large chunks of the works of
Descartes and Plato. Each of these philosophers discuss
extensively phenomena which lie beyond the natural
world. Apart from discussing God, Descartes (1970) famously argued for the existence of a spiritual mind-stuff.
Plato (1955), equally famously, posited the existence of a
world of forms beyond the natural world. So it seems
plausible to claim that Simmons’ definition of philosophy
(or even metaphysics) is open to very serious objection.
Three components
In an excellent paper, Salsberry (1994) tries to set out what
is described as a philosophy of nursing. This involves, she
suggests, three components. First, an ontology which
informs us what the fundamental entities are that exist within the
p. 15). Given the centrality of human beings to the nursing
enterprise this is evidently a plausible claim.
In spite of the excellence of Salsberry’s paper, a worry
remains. Why is she concerned to set out a philosophy of
nursing rather than to characterise philosophy of nursing
per se? The claim that one is developing a philosophy of
nursing clearly implies that there are other possible philosophies of nursing. The title of Salsberry’s paper (A philosophy of nursing: what is it? what is it not?) suggests that
she is out to characterize one member of a class — the
class of philosophies of nursing — as opposed to setting
out, more generally, the criteria for membership of the
class. In other words, she deliberately omits to give an
account of philosophy of nursing in favour of giving an
account of one particular philosophy of nursing.
Ideology and philosophy
The reasons why it matters whether Salsberry is characterising philosophy of nursing and not merely a philosophy of nursing are these. First, the expression a
philosophy of nursing brings to mind the confusion to
which Schrock draws attention, namely, that between an
ideology of nursing and philosophy of nursing. The reason
that the expression ‘a philosophy of nursing’ may lead to
such a conflation stems partly from the currency of
expressions such as ‘I like your philosophy’ or ‘what is
your philosophy?’. These colloquial uses of the term are
far removed from academic philosophy (Schrock, 1981b).
Second, and perhaps more seriously, the question ‘what
is a philosophy of nursing?’ neglects to address what is
clearly the prior question: ‘what is philosophy of nursing?’.
The priority of this second question is evident since, as
noted, any one specific philosophy of nursing can only be
an instance of the subject-area denoted by the expression
‘philosophy of nursing’.
It seems, then, that there is some disagreement amongst
nurse theorists regarding the answer to the question of just
what philosophy of nursing is. It is the burden of the
remainder of this paper to try to shed some light on the
answer to this question.
domain of nursing
(Salsberry 1994 p. 13)
Second, an epistemology which involves ‘claims about
how the basic phenomena can be known’ (Salsberry 1994
p. 13). And third, an ethics: ‘statements about what one
values’ (Salsberry 1994 p. ??). Salsberry suggests that these
three components comprise the form of a philosophy of
nursing as opposed to the substance of such a philosophy.
The reason is that identification of these three components
leaves open precisely how they may be completed. For
example, with respect to the ontological component, the
substance of that component is likely to include ‘content
regarding the nature of human beings’ (Salsberry 1994
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WHAT IS PHILOSOPHY? PHILOSOPHERS
SPEAK
It was noted earlier that if applied philosophy is a part of
philosophy, then philosophy of nursing must be also. An
answer to the question of what philosophy of nursing is
presupposes an answer to the question of what philosophy
is. However, as Schrock (1981b) points out, there is disagreement amongst philosophers concerning the answer
to this question. One quite narrow conception is the
so-called ‘underlabourer’ view of philosophy which
derives from Locke (1690). According to this view, philosophy is to be characterised in terms of the methods it
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093
Philosophy of nursing
employs and in terms of the purposes for which its
methods are employed. Roughly, the relevant methods
include conceptual analysis and assessment of argument.
The purpose behind the application of these methods is
that of ‘removing impediments to the advance of our
understanding’ (Winch 1958 p. 4). This might consist in
drawing attention to inconsistencies in the claims of nurse
theorists, or to conceptual unclarity in their writing.
A difficulty with the underlabourer conception, raised
by Winch, is this. The underlabourer view leaves philosophy without any subject matter of its own. As Winch puts
it, ‘On this view philosophy is [entirely] parasitic on other
disciplines’ (Winch 1958 p. 4). This is the case since on
the underlabourer view the tasks of philosophy are set by
claims made in other disciplines. These claims provide
the subject matter of philosophy.
Winch points out that the underlabourer conception
cannot provide an exhaustive account of philosophy. The
reason is that two of the main areas of philosophy, metaphysics and epistemology, are characterised by problems
which are distinctly philosophical. For example, the concerns of metaphysics centrally include existence-questions
such as: do I exist? are there other selves? are there physical objects? is there an external world? Clearly, these are
not questions which figure centrally in other disciplines.
Rather, it is the case that answers to such questions are
presupposed in other disciplines. For example, all the sciences presuppose an answer to the question: is there an
external world? And human psychology presupposes
the existence of persons. So Winch’s case against the
underlabourer view seems a convincing one.
draws attention. Roughly, the character of such questions
can be exemplified in two ways. The first exploits a contrast between philosophical and scientific questions. For
example, Bird (1972) draws attention to the following
quote from Peters
Very crudely, the claim here is that scientific questions
are characterised by agreement concerning what is sought
and how it can be sought. So, for example, given an agreed
definition of, say, schizophrenia, an epidemiologist may
be able to plot the incidence of that condition in a given
population. But philosophical questions focus on the concepts presupposed in such a procedure. Most obviously,
these will include those of schizophrenia and illness. Less
obviously, they will include the concept of a person. As
Schrock indicates, it is evident that scientific questions
and methods presuppose certain philosophical questions.
These will include tacit agreement regarding what is to
count as an instance of a particular concept (in the
example just given this is schizophrenia); and also tacit
agreement upon how to proceed in order to make such
identifications. The former task, in philosophical terms, is
an ontological task; the latter task is an epistemological
one.
Substantial conception required
Internal and external questions
Evidently, a more substantial conception of philosophy
than that which arises in the underlabourer view is
required. The more substantial conception is one according to which underlabouring, so to speak, still constitutes
philosophical activity. But it does not exhaust philosophical activity. A concern with certain highly general
existence-questions of the kind given earlier remains distinctively philosophical. As does, also, a highly general
concern with epistemological questions concerning, for
example, the criteria for what constitutes knowledge. So a
rejection of the view that the underlabourer conception
provides an exhaustive account of philosophy does not
imply that the tasks of conceptual analysis and assessment
of argument are not fundamental to philosophy. As noted,
Winch’s case suggests the need for a more substantial
account of philosophy. It is one in which philosophy
involves the posing of questions of a distinctive character
or level, but in which conceptual analysis and assessment
of argument remain central.
The suggestion that philosophical questions have such
a distinctive character is one to which Schrock (1981a)
A second, related, way in which the distinctive character
of philosophical questions can be identified is by making
use of Carnap’s (1950) distinction between internal and
external questions. Roughly, Carnap develops the notion
of linguistic frameworks. He suggests that all such frameworks rely upon the truth of certain propositions. For
example, suppose that our ordinary discourse concerning
everyday, physical objects constitutes a linguistic framework. In order for it to be true to judge that something is
a table it has to be true that there are physical objects.
Obviously, if there are no physical objects, one cannot
truly assert of a thing that it is a physical object. Carnap
proposes that internal questions are questions which presuppose the very general claims upon which discourse
within a framework depends for its intelligibility. So in
the example just given the question ‘is this a table or a
chair?’ counts as an internal question. It is internal to the
relevant linguistic framework in the sense that its intelligibility depends upon highly general framework propositions (such as: ‘There are physical objects’). External
questions are those which centre on the general framework
A scientific question, for instance, is one that can in principle be
answered by certain kinds of procedures in which observation
and experiment play a crucial part. But the clarification and discussion of the concepts used and of how they have meaning,
and of the procedures by means of which these questions are
answered, is a philosophical enquiry
(Peters 1966 p. 16)
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093
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S.D. Edwards
propositions themselves. So in relation to our present
example, the question ‘are there physical objects?’ counts
as an external question. It is a question addressed at the
level of the framework as a whole.
Carnap (1950) proposes that such external questions are,
in fact, philosophical questions, their distinctive, philosophical character derives from the fact that they are
directed at very basic presuppositions; presuppositions
upon which the intelligibility of discourse within the
relevant linguistic framework depends.
Nursing discourse
Carnap allows that linguistic frameworks need not be so
general as that just discussed. And this is a view which
has been developed by, for example, Wittgenstein (1979).
It can be claimed that nursing discourse constitutes a
linguistic framework. Its intelligibility presupposes the
truth of certain general claims which can be termed framework propositions. Obvious examples of such framework
propositions include: ‘There are nurses’, ‘There are
patients and clients’, ‘Illness exists’; ‘Health exists’; ‘There
are disease-entities’ and so on. As is implied by Salsberry’s
paper, these framework propositions characterise, at least
partly, the ontology of nursing.
Given acceptance of the claim that nursing discourse is
a linguistic framework, examples of both internal and
external questions can be identified. An example of an
internal question is ‘Is Smith a nurse?’ An example of an
external question is ‘Are there such things as nurses?’ This
question has the philosophical character which Carnap
identifies in external questions. Evidently, in order to
answer the external question just posed is it necessary to
examine what being a nurse amounts to — to answer the
question, ‘What is a nurse?’
The claim being put forward here, then, is that questions
which focus on the framework propositions of linguistic
frameworks are philosophical in character. This character
is evidenced by the fact that they are directed at the presuppositions of the linguistic frameworks as these are set
out in framework propositions. It should be added that
questions regarding the understanding of the concepts
which constitute framework propositions also count as
philosophical questions. So, for example, in relation to
nursing discourse an examination of the concept of a nurse
counts as a philosophical examination. For, the concept
nurse features in the framework propositions upon which
nursing discourse depends for its intelligibility.
W HAT IS PHILOSOPHY OF NURSING?
So far, three elements of philosophical enquiry have been
identified. The first is the kind of analysis which comprises
the underlabourer view. The second is the concern with
particular problems traditionally regarded as philosophi1092
cal problems (e.g. those of metaphysics and epistemology).
And the third element of philosophical enquiry involves
the development of a criterion for the identification of
philosophical questions. Such questions are those which
Carnap describes as external questions.
The identification of these three elements of philosophical enquiry supports the proposal that philosophy of nursing should similarly be comprised of the three elements.
That is, if philosophy involves these three elements, then
so too must philosophy of nursing. In this context philosophy of nursing would be said to involve the following.
First, conceptual clarification and assessment of arguments. Second, consideration of traditional philosophical
problems which have relevance to nursing theory and
practice (clearly, this relevance would need to be made
explicit). And third, in the light of our discussion of
Carnap’s claims, it can be asserted that the concerns of
philosophy of nursing would include a focus on the framework propositions which constitute nursing discourse
and on the concepts of which those propositions are
comprised.
Consider, then, Salsberry’s claims regarding a philosophy of nursing in terms of this account of what philosophy of nursing amounts to. The charge made above
against Salsberry is that she neglects to consider the prior,
more general question of what philosophy of nursing is.
Conceptual clarification and assessment of
argument
It seems to me that the characterisation just offered of philosophy of nursing sits rather well with Salsberry’s description of a philosophy of nursing. For, a philosophy of
nursing, if it can be formulated, must arise from application of the three elements of philosophy of nursing
identified above. Evidently, formulation of a philosophy
of nursing must involve conceptual clarification and
assessment of argument. For example, such clarifications
may focus upon the concept of a nurse, or of a patient etc.,
and on arguments deployed in support of particular conclusions. Further, a philosophy of nursing can be expected
to take into account relevant traditional philosophical
problems.
For example, as Salsberry suggests, the ontological component of a philosophy of nursing must include human
beings, or persons. Hence, any such component must take
into account the traditional philosophical problems of personal identity and of the relationship between the mind
and the body. Also, sensitivity to the distinction which
Carnap raises between internal and external questions
must also be present in the formulation of a philosophy of
nursing. For, the propositions and concepts which comprise the linguistic framework of nursing discourse will
be the focus of philosophical enquiry in nursing. And formulation of a philosophy of nursing will necessarily
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 1089–1093
Philosophy of nursing
involve the development of such framework propositions — what Salsberry describes as the substance of a
philosophy of nursing as opposed to its form.
CONCLUSION
At the start of this paper two possible audiences were
referred to, philosophers and nurse theorists. It is hoped
that the above articulation of philosophy of nursing will
persuade those philosophers who are sceptical of the legitimacy of such an enterprise that it is founded upon respectable and fundamental philosophical traditions.
These include the activities of conceptual analysis and
assessment of argument, concern with general existence
and knowledge questions; and the recruitment of Carnap’s
internal/external questions distinction to aid identification
of philosophical questions.
Finally, it is hoped that the articulation of philosophy
of nursing attempted in the paper is also of help to nurse
theorists.
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