Running head: DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE
Defining the Art of Nursing: Understanding Techne, Theoria, and Phronesis
Teresa D. Welch
The University of Alabama
Seminar in Curriculum Leadership
AEL 695
Douglas McKnight, Ph.D.
November 30, 2013
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DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE
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Defining the Art of Nursing: Understanding Techne, Theoria, and Phronesis
Wide-spread transformative changes in the United States health care system and practice
environments will demand equally profound changes in the professional practice and educational
preparation of nurses to prepare them for this cacophony of change called health care reform
(Institute of Medicine of the National Academies and the Robert Wood Johnson Foundation
[IOM], 2011). “Nurses must learn how to assess, use, and manage knowledge, rather than trying
to pack thousands of facts into their heads, hoping to be able to retrieve them when needed”
(Stokowski, 2011, para. 7). We need to hardwire the processes that promote and sustain real
time, point of care access, to and management of knowledge in both education and nursing.
Furthermore, nurse educators need to improve the linkages between knowledge, clinical
reasoning, and professional practice as care within the hospital setting continues to grow more
diverse and complex, and nurses are required to make critical decisions that involve sicker,
frailer patients (Stokowski, 2011). Care in this setting depends upon sophisticated, life-saving
technology coupled with complex information management systems that require skill in the
analysis and synthesis of information at the point of care (Institute of Medicine of the National
Academies [IOM], 2011). “Our progress of knowledge is subject to the law of increasing
specialization and, hence, to increasing obstacles to comprehensiveness” (Gadamer, 1977, p. 10).
In the face of this dynamic environment it is crucial that entry level nurses have the
requisite competencies, and critical thinking skills to successfully navigate the complexities of
health care while at the same time meeting the demands of professional practice. Furthermore,
education should support a smooth transition from the academic environment to a host of
practice environments upon graduation (Stokowski, 2011). With these tectonic factors at play
demanding startling change, we must look to our past to provide the foundation of change and
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the clarity of purpose to tie theory to practice. A firm understanding of this connection will serve
to improve practice and help rescue it from its own vagaries and perplexities (Dunne, 2009).
“Philosophy will serve us only if we surrender to it. The original problem does not remain in a
position to dictate what the terms of the conversation will be but is itself assumed into and
transformed by it” (Dunne, 2009, p. 21).
Theoria
In his analysis of Aristotle’s ethics Dunne states:
In the Nicomachean Ethics, where Aristotle speaks of the ‘self-sufficiency’ of
theory, and tells us that it is ‘loved for its own sake; for nothing arises from it apart
from the contemplating [to theoresai] while from practical activities we gain more
or less apart from the action. Theoretical knowledge, thus is conceived, was
emphatically distinguished from any knowledge which might have practical
import (Dunne, 2009, p. 238).
Theoria is beyond action yielding no product tangible or intangible; knowledge solely for
the sake of knowledge. According to Aristotle’s teachings “theoria is superior to any other. In
fact it is higher than human” (Adkins, 1978). Material goods maybe necessary for the life of
practical arête (excellence), but the theoretikos (deep contemplation) does not need material
artifacts. Artifacts may actually impede realization of theoria (Adkins, 1978). According to
Gadamer (1977) theory quite literally means “observation, simply looking on, perceiving how
things are or reveal themselves to be” independent of our own personal desires and interests: An
authentic reality without personal influence to prejudice the cognitive impressions. However, it
is prudent to acknowledge that as Kant noted in his famous work, Critique of Pure Reason,
“there is no doubt that all of our knowledge begins with experience”. This premise also holds
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true for the knowledge that we possess as human beings and filters or influences all interactions
and thought. This would include the experiential knowledge of so-called practice that everyone
accumulates throughout their lifetime. Furthermore, moving beyond first-hand experience there
is that “vast wealth of knowledge which flows towards each and every human being in the
transmission of human culture”. Knowledge that is ‘subjective’ largely unverifiable and
unstable, but, nevertheless, knowledge that cannot be disregarded by science. (Gadamer, 1977).
According to Gadamer science is the highest intensification of the knowledge that guides
practice recognizing itself as pure theoria (knowledge sought for its own sake and not for its
practical significance). Furthermore, “science makes possible knowledge directed to the power
of making, a knowing mastery of nature. This is technology. And this is precisely what practice
is not. Technology is not knowledge that steadily grows with experience; it is acquired from
practice” (Gadamer, 1977, p. 4-5).
Techne
In the introduction of his book, The Enigma of Health, Gadamer (1977) made the
observation that, “everywhere it is a question of finding the right balance between our technical
capacities and the need for responsible actions and choice”( p. ix). “Aristotle used techne to
specify craft making, and not as a general reference to a body of knowledge” (Polkinghorne,
2004, p. 112). Simply put, techne is skill based knowledge that provides a rational plan of action
(Butler, 2006).
Polkinghorne provided an excellent example to demonstrate the concept of techne:
Techne is the reasoning used to develop the knowledge to bring about a desired
change, for example, transforming a lump of clay into a bowl for serving food.
The goal of the action was established before production began. The procedure
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does not determine the end (telos) but comes to the task with the end (telos)
already established. Knowing what end (telos) is to be accomplished, the producer
can use techne to figure out the procedure that will transform the material into the
desired object. The actual manufacture of the object (poiesis) follows the steps that
have been worked out through techne reasoning. It is the reasoning used to
develop plans for the production of artifacts. Once a plan has been developed
through techne it can be used repeatedly on the same type of materials and will
consistently yield the same result (Polkinghorne, 2004, p. 115)
Aristotle specifically used medicine as his standard example for the transformation of the
purely practical accumulation of skill and knowledge into genuine science. According to the
teachings of Aristotle the physician grasps the universal to connect cause and effect, to
comprehend the reason why a particular form of healing meets with success and another will not.
“Techne is that knowledge which constitutes a specific and tried ability in the context of
producing things [health]” (Gadamer, 1977, p. 32).
“Techne provides the kind of knowledge possessed by an expert in one of the specialized
crafts, a person who understands the principles underlying the production of an object or state of
affairs, e.g. a house, table, a safe journey or state of being healthy" (Dunne, 2009, p. 244).
Phronesis
The concept of phronesis describes a person who knows how to live well and is
demonstrated in their behavior and actions as they interact with others within the community. It
is deeply personal in that, phronesis is reflected within the living of one’s life and characterizes
the kind of person that they are (Dunne, 2009)
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According to Gadamer’s (1975) interpretation of Aristotle’s perception of phronesis, it is
the knowledge of self. This introspective knowledge cannot be learned or forgotten; it is ethical
and moral in character and, as such, it is the supreme influence on an individual’s actions. It is
obvious that skills based knowledge (techne) and theoretical knowledge (theoria, Sophia, or
episteme) are guided by the ‘self-knowledge’ (phronesis) in significant and social interactions. In
doing so, ‘self-knowledge’ embraces both the means and the ends of social action (Butler, 2006).
Phronesis is the excellence by which one deliberates well about what to do in the human realm.
It is the process of reasoning used to make the appropriate practical choices that constitute a
good life. Aristotle acknowledges that there are multiple facet’s to the ‘good life. When dealing
with the unpredictable social sciences, situations and circumstances change and are dependent
upon a myriad of influences. Phronetic decision making is more complex than Plato’s deductive
thought processes and typically does not produce the same calculated mathematical answers;
emotional and imaginative processes influence practical deliberation and the reasoning process
(Polkinghorne, 2004).
Quoting from the Nicomachean Ethics, Book 6, “VII. Wisdom is the most accurate of all
knowledge. It knows the principles, and the facts deduced from them. It is therefore, intuition
and science combined together” (Browne, 1853, Book. VI p. 65). Phronesis is the practical
wisdom that enables you to successfully foster another’s well-being. The Greeks used the word
phronesis to refer to the know-how that fosters that good; making both the moral and the
practical decisions that are required in nursing an intuitive judgment that draws from life’s
experiences (Bishop & Scudder, 2001). This experience is more than what we face in the
hospitals and clinics. It is the totality of our cumulative experiences of living and maturation
that we draw upon when we have to make these moral and practical decisions in our daily walk.
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Telos
Quoting from Browne’s translation and analysis of Aristotle’s Nicomachaen Ethic’s:
Every art, system course of action, and deliberate preference, aims at some good.
Hence the good is defined ‘that which all aim at’. There are differences of ends;
namely, energies and works. The ends of the master-arts are more eligible than the
ends of those subordinate to them. This is the case, even though the end of the
master-art is an energy, and that of the subordinate art a work. II. There is some
end of human action which is desired for its own sake. It is the end of that which is
the master-science in the highest sense; i.e. the political. The political science
proved to be the chief science several reasons and examples. The knowledge of the
end useful. The subject of the ‘the end’ belongs to the moral, and the therefore to
political philosophy” (Browne, 1853, Book I p. 14)
Any literature review delving into Aristotelian ethics discusses the concept of telos.
Understanding this concept will bring clarity to the discussion of theoria and techne. Simply
translated telos means ‘end’ or ‘goal’. The significance of this concept lies within the realization
of the import it carries for the other concepts, particularly theoria. Theoria is the end in and of
itself.
“Aristotle claims that in order to determine the just distribution of a good, we have to
inquire into the telos, or purpose, of the good being distributed. The purpose of flutes is to
produce excellent music. Those who can best realize this purpose ought to have the best ones.”
(Sandel, 2009, p. 188).
Restated, telos is a rational choice. The ‘rightness’ of that action is
determined by the purpose for which the action was undertaken in the first place. (Majithia,
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2006). As previously quoted on the previous page, the first sentence of the Ethics tells us that
every activity aims at a certain telos.
Relevance to Nursing
Aristotle views education as a tool to improve human beings present circumstance in
their quest for livelihood, materials, or happiness. These teachings have had a profound impact
on the field of nursing, and are reflected in the concepts of techna (technology), theoria (theory),
and phronesis (profound wisdom or knowledge, and telos (the end). The fact that we mingle
with our environment in every breath is absolutely recognized in the field of nursing, in which
metabolic life is simultaneously ecological and socially interdependent (Elstad & Torjuul, 2009).
Naturally there is always application of knowledge to practice, as indicated by the very
terms ‘sciences’ (epistemai) and ‘arts’ (technai). Practice means not only the making of
whatever one can make; it is also choice and decision between possibilities. Practice always has
a relationship to a person’s ‘being’. This is reflected in the figurative expression: what are you
doing, but rather, how are you doing? Practice requires knowledge, which means that it is
obliged to treat the knowledge available at the time as complete and certain.
The Greeks transformed know-how and knowledge into a knowledge of principles and
thus demonstrable knowledge which one became aware of to enjoy for its own sake out of a
primary curiosity about the world. (Gadamer, 1977, p. 4-5). “Aristotle’s philosophy is
particularly relevant to nursing” (Elstad & Torjuul, 2009). “To Aristotle, natural processes and
human activities ultimately have the same ends, since cosmos unites nature and human society.
Good actions contribute to the supreme telos of human life, of living well through its course.
This is the basis for his distinction, much used in nursing ethics, between making (poiesis) which
is an end other than itself and action (praxis) which itself is its end” (Elstad & Torjuul, 2009).
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Aristotle briefly discussed the concept of phronetic reasoning in a single book of the
Nicomachean Ethics. He focused on how to choose the best plan that would result in the correct
practical action. Aristotle, according to Polkinghorne (2004) believed that “ an agent with the
proper dispositions and developed perceptive capacity can make the right choice through the use
of deliberation” (p. 120). However, health care providers do not make single isolated choices to
be carried out. They are engaged with people that they serve over time. They continually have to
make choices about what to do next as they interact with the people. Healthcare providers act
then react upon observed responses to their actions. They engage in conversation with others
who are also involved in choosing goal-directed actions. The give and take of their person-toperson interaction places their choices in a constantly shifting context. “Phronetic reasoning
involves more than simply deciding what to do in the beginning; practitioners have to monitor
the responses to their choices and adjust subsequent actions accordingly” (Polkinghorne, 2004, p.
120).
We can further examine the concept of phronesis through the discourses of nursing
education. Historically, there has been an educational debate within the academic and
professional bodies of nursing; the technical versus professional nurse. The associate nurse with
the two year nursing degree has been coined the ‘technical’ nurse, while the four year
baccalaureate nurse has been considered the ‘professional’ nurse (Mahaffey, 2002). All nurses
regardless of educational preparation must successfully sit for the NCLEX licensure exam. This
examination publically proclaims that it is strictly an assessment of minimal competence
(Mahaffey, 2002) (Sewell, 2007). The complexity and politics of this debate are well beyond the
bounds of this paper. It is only mentioned to demonstrate the differences found within the techne
and the phronetic.
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The philosophy of nursing education and practice found within associate degree
programs focus on the requisite technical skills of the nurse rather than the theory, the
knowledge, the understanding of principles (Mahaffery, 2002). This has similarities with that of
the ancient Greek philosophers and their mode of reasoning called techne. Does techne or the
learned practical skills of nursing adequately prepare the nurse to deal with the ambiguities of
everyday nursing practice? The experienced clinical nurse would assert that while education and
knowledge are essential, they are not the only concepts vital to nursing practice. Logically it
would follow that the more knowledgeable and self-reflective the nurse, the broader the
knowledge base, the better the practice. The definition of a professional nurse would then be
someone who not only has a firm grasp of the techne through evidence based practice but who
also understands the universal and demonstrates the intuitive reasoning to pull it all together for
the betterment of the individual cared for. The art of the nursing profession lies within a
phronetic, ontological practice in which a nurse's morals, habits, and predispositions guide
practice.
You can be an expert in the technical realm but never achieve the attributes of excellence
in the art of nursing. To transcend from good/ competent to great/ excellent the nurse must
embrace and master the concepts of theoria, techne and phronesis. We must learn to find
ourselves, find our own way within this highly regulated and complex bureaucratic environment
of healthcare to be able to meet the needs of our patients (Gadamer, 1977). “Aristotelian theory
may thus provide a useful methodology for health care theorists, both in terms of looking at
practice (and its place in education) and in terms of identifying and dealing with the ethical
issues involved” (Scott, 1995, para. 3).
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Conclusion
“… The social role of individuals rather than their self-understanding moves into the
foreground” (Gadamer, 1977, p. 11). This article has argued that an understanding of phronesis
and techne as the two primordial components of individual practical knowledge are vital for
researchers and practitioners… (Butler, 2006, p. 4). Aristotle’s lifework is a testament to
education and a belief that everyone should have a clear philosophy of life. A review of the
literature supports the influence of his teachings in philosophy and ethics to medical and nursing
students and indicates an increasing interest not only with duties, rights and consequences but
with the character of health care practitioners (Scott, 1995). We must continually ask ourselves
what makes for human flourishing. From this we should work for that which is good or ‘right’,
rather than that which is merely ‘correct’.
Quoting from Aristotle’s Nicomachean Ethics Book II:
Virtue being twofold, one part intellectual and the other moral, intellectual virtue has its
origin and increase for the most part from teaching; therefore it stands in need of
experience and time; but moral virtue arises from habit, whence also it has got its
name, which is only in a small degree altered (Browne, 1853, p. 33).
Nurses are taught the physical and technical skills necessary to pass the individual 'State
Boards' demonstrating minimal competence, but that does not imply nor infer that that nurse has
acquired the episteme, the techne nor the phronetic awareness to be proficient in the art of
nursing. An ‘excellent’ nurse must also be able to direct and coordinate the work of others, in all
departments, to care for the "whole" person emotionally, physically, and practically (Sewell,
2007). Technique and narrow rational technicality alone cannot address interpersonal and
relational responsibilities, discernment, and situated possibilities required by caring for persons
DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE
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made vulnerable by illness and injury. Phronesis is required. Means and ends are inextricably
related in caring for the sick and ill. The clinician and the patient bend and respond to the other
so the horizons and the world are opened and reconstituted, allowing new possibilities to emerge
(Benner, Tanner, & Chelsea, 2009). Aristotelian virtue theory provides a practice-based focus
for health care ethics. Also, because of his emphasis on the character of the moral agent, and on
the importance of perception and emotion in moral decision-making, Aristotelian virtue theory
provides a useful supplement to the traditional duty-based approaches to health care ethics
analysis, which are increasingly being identified in the literature as having limits to their
application within the health care context. Given that an ethical dimension underlies much, if not
all, of nursing practice, it seems important that nurses are enabled to develop an ethical
awareness and sensitivity from early on in their initial professional education programs (Scott,
1995).
As a nurse and caregiver it is imperative to have an understanding of your own ethical
and philosophical values and viewpoints. To have that understanding and self-awareness implies
an emotional maturity that facilitates strong and effective interpersonal relationships with your
co-workers, patients and families. The ability and capacity to demonstrate a strong selfawareness implies a high degree of emotional intelligence. We are more effective in everything
that we do when we understand ourselves, the way we think, and where our values are in relation
to others as well as our personal strengths and limitations (Gokenbach, n.d.).
DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE
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