Nursing Philosophy...It Matters

A Tribute to MLK: Why Ideals Matter...and It Matters Where You Find Your Ideals - Letter from a Birmingham Jail

2012-01-16T23:28:00.000-06:00

If you read nothing else today, read this:

"Letter from a Birmingham Jail"

16 April 1963

My Dear Fellow Clergymen:

While confined here in the Birmingham city jail, I came across your recent statement calling my present activities "unwise and untimely." Seldom do I pause to answer criticism of my work and ideas. If I sought to answer all the criticisms that cross my desk, my secretaries would have little time for anything other than such correspondence in the course of the day, and I would have no time for constructive work. But since I feel that you are men of genuine good will and that your criticisms are sincerely set forth, I want to try to answer your statement in what I hope will be patient and reasonable terms.

I think I should indicate why I am here in Birmingham, since you have been influenced by the view which argues against "outsiders coming in." I have the honor of serving as president of the Southern Christian Leadership Conference, an organization operating in every southern state, with headquarters in Atlanta, Georgia. We have some eighty five affiliated organizations across the South, and one of them is the Alabama Christian Movement for Human Rights. Frequently we share staff, educational and financial resources with our affiliates. Several months ago the affiliate here in Birmingham asked us to be on call to engage in a nonviolent direct action program if such were deemed necessary. We readily consented, and when the hour came we lived up to our promise. So I, along with several members of my staff, am here because I was invited here. I am here because I have organizational ties here.

But more basically, I am in Birmingham because injustice is here. Just as the prophets of the eighth century B.C. left their villages and carried their "thus saith the Lord" far beyond the boundaries of their home towns, and just as the Apostle Paul left his village of Tarsus and carried the gospel of Jesus Christ to the far corners of the Greco Roman world, so am I compelled to carry the gospel of freedom beyond my own home town. Like Paul, I must constantly respond to the Macedonian call for aid.

Moreover, I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in Birmingham. Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial "outside agitator" idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds.

You deplore the demonstrations taking place in Birmingham. But your statement, I am sorry to say, fails to express a similar concern for the conditions that brought about the demonstrations. I am sure that none of you would want to rest content with the superficial kind of social analysis that deals merely with effects and does not grapple with underlying causes. It is unfortunate that demonstrations are taking place in Birmingham, but it is even more unfortunate that the city's white power structure left the Negro community with no alternative.

In any nonviolent campaign there are four basic steps: collection of the facts to determine whether injustices exist; negotiation; self purification; and direct action. We have gone through all these steps in Birmingham. There can be no gainsaying the fact that racial injustice engulfs this community. Birmingham is probably the most thoroughly segregated city in the United States. Its ugly record of brutality is widely known. Negroes have experienced grossly unjust treatment in the courts. There have been more unsolved bombings of Negro homes and churches in Birmingham than in any other city in the nation. These are the hard, brutal facts of the case. On the basis of these conditions, Negro leaders sought to negotiate with the city fathers. But the latter consistently refused to engage in good faith negotiation.

Then, last September, came the opportunity to talk with leaders of Birmingham's economic community. In the course of the negotiations, certain promises were made by the merchants--for example, to remove the stores' humiliating racial signs. On the basis of these promises, the Reverend Fred Shuttlesworth and the leaders of the Alabama Christian Movement for Human Rights agreed to a moratorium on all demonstrations. As the weeks and months went by, we realized that we were the victims of a broken promise. A few signs, briefly removed, returned; the others remained. As in so many past experiences, our hopes had been blasted, and the shadow of deep disappointment settled upon us. We had no alternative except to prepare for direct action, whereby we would present our very bodies as a means of laying our case before the conscience of the local and the national community. Mindful of the difficulties involved, we decided to undertake a process of self purification. We began a series of workshops on nonviolence, and we repeatedly asked ourselves: "Are you able to accept blows without retaliating?" "Are you able to endure the ordeal of jail?" We decided to schedule our direct action program for the Easter season, realizing that except for Christmas, this is the main shopping period of the year. Knowing that a strong economic-withdrawal program would be the by product of direct action, we felt that this would be the best time to bring pressure to bear on the merchants for the needed change.

Then it occurred to us that Birmingham's mayoral election was coming up in March, and we speedily decided to postpone action until after election day. When we discovered that the Commissioner of Public Safety, Eugene "Bull" Connor, had piled up enough votes to be in the run off, we decided again to postpone action until the day after the run off so that the demonstrations could not be used to cloud the issues. Like many others, we waited to see Mr. Connor defeated, and to this end we endured postponement after postponement. Having aided in this community need, we felt that our direct action program could be delayed no longer.

You may well ask: "Why direct action? Why sit ins, marches and so forth? Isn't negotiation a better path?" You are quite right in calling for negotiation. Indeed, this is the very purpose of direct action. Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored. My citing the creation of tension as part of the work of the nonviolent resister may sound rather shocking. But I must confess that I am not afraid of the word "tension." I have earnestly opposed violent tension, but there is a type of constructive, nonviolent tension which is necessary for growth. Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half truths to the unfettered realm of creative analysis and objective appraisal, so must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood. The purpose of our direct action program is to create a situation so crisis packed that it will inevitably open the door to negotiation. I therefore concur with you in your call for negotiation. Too long has our beloved Southland been bogged down in a tragic effort to live in monologue rather than dialogue.

One of the basic points in your statement is that the action that I and my associates have taken in Birmingham is untimely. Some have asked: "Why didn't you give the new city administration time to act?" The only answer that I can give to this query is that the new Birmingham administration must be prodded about as much as the outgoing one, before it will act. We are sadly mistaken if we feel that the election of Albert Boutwell as mayor will bring the millennium to Birmingham. While Mr. Boutwell is a much more gentle person than Mr. Connor, they are both segregationists, dedicated to maintenance of the status quo. I have hope that Mr. Boutwell will be reasonable enough to see the futility of massive resistance to desegregation. But he will not see this without pressure from devotees of civil rights. My friends, I must say to you that we have not made a single gain in civil rights without determined legal and nonviolent pressure. Lamentably, it is an historical fact that privileged groups seldom give up their privileges voluntarily. Individuals may see the moral light and voluntarily give up their unjust posture; but, as Reinhold Niebuhr has reminded us, groups tend to be more immoral than individuals.

We know through painful experience that freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed. Frankly, I have yet to engage in a direct action campaign that was "well timed" in the view of those who have not suffered unduly from the disease of segregation. For years now I have heard the word "Wait!" It rings in the ear of every Negro with piercing familiarity. This "Wait" has almost always meant "Never." We must come to see, with one of our distinguished jurists, that "justice too long delayed is justice denied."

We have waited for more than 340 years for our constitutional and God given rights. The nations of Asia and Africa are moving with jetlike speed toward gaining political independence, but we still creep at horse and buggy pace toward gaining a cup of coffee at a lunch counter. Perhaps it is easy for those who have never felt the stinging darts of segregation to say, "Wait." But when you have seen vicious mobs lynch your mothers and fathers at will and drown your sisters and brothers at whim; when you have seen hate filled policemen curse, kick and even kill your black brothers and sisters; when you see the vast majority of your twenty million Negro brothers smothering in an airtight cage of poverty in the midst of an affluent society; when you suddenly find your tongue twisted and your speech stammering as you seek to explain to your six year old daughter why she can't go to the public amusement park that has just been advertised on television, and see tears welling up in her eyes when she is told that Funtown is closed to colored children, and see ominous clouds of inferiority beginning to form in her little mental sky, and see her beginning to distort her personality by developing an unconscious bitterness toward white people; when you have to concoct an answer for a five year old son who is asking: "Daddy, why do white people treat colored people so mean?"; when you take a cross county drive and find it necessary to sleep night after night in the uncomfortable corners of your automobile because no motel will accept you; when you are humiliated day in and day out by nagging signs reading "white" and "colored"; when your first name becomes "nigger," your middle name becomes "boy" (however old you are) and your last name becomes "John," and your wife and mother are never given the respected title "Mrs."; when you are harried by day and haunted by night by the fact that you are a Negro, living constantly at tiptoe stance, never quite knowing what to expect next, and are plagued with inner fears and outer resentments; when you are forever fighting a degenerating sense of "nobodiness"--then you will understand why we find it difficult to wait. There comes a time when the cup of endurance runs over, and men are no longer willing to be plunged into the abyss of despair. I hope, sirs, you can understand our legitimate and unavoidable impatience. You express a great deal of anxiety over our willingness to break laws. This is certainly a legitimate concern. Since we so diligently urge people to obey the Supreme Court's decision of 1954 outlawing segregation in the public schools, at first glance it may seem rather paradoxical for us consciously to break laws. One may well ask: "How can you advocate breaking some laws and obeying others?" The answer lies in the fact that there are two types of laws: just and unjust. I would be the first to advocate obeying just laws. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that "an unjust law is no law at all."

Now, what is the difference between the two? How does one determine whether a law is just or unjust? A just law is a man made code that squares with the moral law or the law of God. An unjust law is a code that is out of harmony with the moral law. To put it in the terms of St. Thomas Aquinas: An unjust law is a human law that is not rooted in eternal law and natural law. Any law that uplifts human personality is just. Any law that degrades human personality is unjust. All segregation statutes are unjust because segregation distorts the soul and damages the personality. It gives the segregator a false sense of superiority and the segregated a false sense of inferiority. Segregation, to use the terminology of the Jewish philosopher Martin Buber, substitutes an "I it" relationship for an "I thou" relationship and ends up relegating persons to the status of things.

Hence segregation is not only politically, economically and sociologically unsound, it is morally wrong and sinful. Paul Tillich has said that sin is separation. Is not segregation an existential expression of man's tragic separation, his awful estrangement, his terrible sinfulness? Thus it is that I can urge men to obey the 1954 decision of the Supreme Court, for it is morally right; and I can urge them to disobey segregation ordinances, for they are morally wrong.

Let us consider a more concrete example of just and unjust laws. An unjust law is a code that a numerical or power majority group compels a minority group to obey but does not make binding on itself. This is difference made legal. By the same token, a just law is a code that a majority compels a minority to follow and that it is willing to follow itself. This is sameness made legal. Let me give another explanation. A law is unjust if it is inflicted on a minority that, as a result of being denied the right to vote, had no part in enacting or devising the law. Who can say that the legislature of Alabama which set up that state's segregation laws was democratically elected? Throughout Alabama all sorts of devious methods are used to prevent Negroes from becoming registered voters, and there are some counties in which, even though Negroes constitute a majority of the population, not a single Negro is registered. Can any law enacted under such circumstances be considered democratically structured?

Sometimes a law is just on its face and unjust in its application. For instance, I have been arrested on a charge of parading without a permit. Now, there is nothing wrong in having an ordinance which requires a permit for a parade. But such an ordinance becomes unjust when it is used to maintain segregation and to deny citizens the First-Amendment privilege of peaceful assembly and protest.

I hope you are able to see the distinction I am trying to point out. In no sense do I advocate evading or defying the law, as would the rabid segregationist. That would lead to anarchy. One who breaks an unjust law must do so openly, lovingly, and with a willingness to accept the penalty. I submit that an individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law.

Of course, there is nothing new about this kind of civil disobedience. It was evidenced sublimely in the refusal of Shadrach, Meshach and Abednego to obey the laws of Nebuchadnezzar, on the ground that a higher moral law was at stake. It was practiced superbly by the early Christians, who were willing to face hungry lions and the excruciating pain of chopping blocks rather than submit to certain unjust laws of the Roman Empire. To a degree, academic freedom is a reality today because Socrates practiced civil disobedience. In our own nation, the Boston Tea Party represented a massive act of civil disobedience.

We should never forget that everything Adolf Hitler did in Germany was "legal" and everything the Hungarian freedom fighters did in Hungary was "illegal." It was "illegal" to aid and comfort a Jew in Hitler's Germany. Even so, I am sure that, had I lived in Germany at the time, I would have aided and comforted my Jewish brothers. If today I lived in a Communist country where certain principles dear to the Christian faith are suppressed, I would openly advocate disobeying that country's antireligious laws.

I must make two honest confessions to you, my Christian and Jewish brothers. First, I must confess that over the past few years I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro's great stumbling block in his stride toward freedom is not the White Citizen's Counciler or the Ku Klux Klanner, but the white moderate, who is more devoted to "order" than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: "I agree with you in the goal you seek, but I cannot agree with your methods of direct action"; who paternalistically believes he can set the timetable for another man's freedom; who lives by a mythical concept of time and who constantly advises the Negro to wait for a "more convenient season." Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.

I had hoped that the white moderate would understand that law and order exist for the purpose of establishing justice and that when they fail in this purpose they become the dangerously structured dams that block the flow of social progress. I had hoped that the white moderate would understand that the present tension in the South is a necessary phase of the transition from an obnoxious negative peace, in which the Negro passively accepted his unjust plight, to a substantive and positive peace, in which all men will respect the dignity and worth of human personality. Actually, we who engage in nonviolent direct action are not the creators of tension. We merely bring to the surface the hidden tension that is already alive. We bring it out in the open, where it can be seen and dealt with.

Like a boil that can never be cured so long as it is covered up but must be opened with all its ugliness to the natural medicines of air and light, injustice must be exposed, with all the tension its exposure creates, to the light of human conscience and the air of national opinion before it can be cured.

In your statement you assert that our actions, even though peaceful, must be condemned because they precipitate violence. But is this a logical assertion? Isn't this like condemning a robbed man because his possession of money precipitated the evil act of robbery? Isn't this like condemning Socrates because his unswerving commitment to truth and his philosophical inquiries precipitated the act by the misguided populace in which they made him drink hemlock? Isn't this like condemning Jesus because his unique God consciousness and never ceasing devotion to God's will precipitated the evil act of crucifixion? We must come to see that, as the federal courts have consistently affirmed, it is wrong to urge an individual to cease his efforts to gain his basic constitutional rights because the quest may precipitate violence. Society must protect the robbed and punish the robber. I had also hoped that the white moderate would reject the myth concerning time in relation to the struggle for freedom. I have just received a letter from a white brother in Texas. He writes: "All Christians know that the colored people will receive equal rights eventually, but it is possible that you are in too great a religious hurry. It has taken Christianity almost two thousand years to accomplish what it has. The teachings of Christ take time to come to earth." Such an attitude stems from a tragic misconception of time, from the strangely irrational notion that there is something in the very flow of time that will inevitably cure all ills. Actually, time itself is neutral; it can be used either destructively or constructively. More and more I feel that the people of ill will have used time much more effectively than have the people of good will. We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people. Human progress never rolls in on wheels of inevitability; it comes through the tireless efforts of men willing to be co workers with God, and without this hard work, time itself becomes an ally of the forces of social stagnation. We must use time creatively, in the knowledge that the time is always ripe to do right. Now is the time to make real the promise of democracy and transform our pending national elegy into a creative psalm of brotherhood. Now is the time to lift our national policy from the quicksand of racial injustice to the solid rock of human dignity.

You speak of our activity in Birmingham as extreme. At first I was rather disappointed that fellow clergymen would see my nonviolent efforts as those of an extremist. I began thinking about the fact that I stand in the middle of two opposing forces in the Negro community. One is a force of complacency, made up in part of Negroes who, as a result of long years of oppression, are so drained of self respect and a sense of "somebodiness" that they have adjusted to segregation; and in part of a few middle-class Negroes who, because of a degree of academic and economic security and because in some ways they profit by segregation, have become insensitive to the problems of the masses. The other force is one of bitterness and hatred, and it comes perilously close to advocating violence. It is expressed in the various black nationalist groups that are springing up across the nation, the largest and best known being Elijah Muhammad's Muslim movement. Nourished by the Negro's frustration over the continued existence of racial discrimination, this movement is made up of people who have lost faith in America, who have absolutely repudiated Christianity, and who have concluded that the white man is an incorrigible "devil."

I have tried to stand between these two forces, saying that we need emulate neither the "do nothingism" of the complacent nor the hatred and despair of the black nationalist. For there is the more excellent way of love and nonviolent protest. I am grateful to God that, through the influence of the Negro church, the way of nonviolence became an integral part of our struggle. If this philosophy had not emerged, by now many streets of the South would, I am convinced, be flowing with blood. And I am further convinced that if our white brothers dismiss as "rabble rousers" and "outside agitators" those of us who employ nonviolent direct action, and if they refuse to support our nonviolent efforts, millions of Negroes will, out of frustration and despair, seek solace and security in black nationalist ideologies--a development that would inevitably lead to a frightening racial nightmare.

Oppressed people cannot remain oppressed forever. The yearning for freedom eventually manifests itself, and that is what has happened to the American Negro. Something within has reminded him of his birthright of freedom, and something without has reminded him that it can be gained. Consciously or unconsciously, he has been caught up by the Zeitgeist, and with his black brothers of Africa and his brown and yellow brothers of Asia, South America and the Caribbean, the United States Negro is moving with a sense of great urgency toward the promised land of racial justice. If one recognizes this vital urge that has engulfed the Negro community, one should readily understand why public demonstrations are taking place. The Negro has many pent up resentments and latent frustrations, and he must release them. So let him march; let him make prayer pilgrimages to the city hall; let him go on freedom rides -and try to understand why he must do so. If his repressed emotions are not released in nonviolent ways, they will seek expression through violence; this is not a threat but a fact of history. So I have not said to my people: "Get rid of your discontent." Rather, I have tried to say that this normal and healthy discontent can be channeled into the creative outlet of nonviolent direct action. And now this approach is being termed extremist. But though I was initially disappointed at being categorized as an extremist, as I continued to think about the matter I gradually gained a measure of satisfaction from the label. Was not Jesus an extremist for love: "Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you." Was not Amos an extremist for justice: "Let justice roll down like waters and righteousness like an ever flowing stream." Was not Paul an extremist for the Christian gospel: "I bear in my body the marks of the Lord Jesus." Was not Martin Luther an extremist: "Here I stand; I cannot do otherwise, so help me God." And John Bunyan: "I will stay in jail to the end of my days before I make a butchery of my conscience." And Abraham Lincoln: "This nation cannot survive half slave and half free." And Thomas Jefferson: "We hold these truths to be self evident, that all men are created equal . . ." So the question is not whether we will be extremists, but what kind of extremists we will be. Will we be extremists for hate or for love? Will we be extremists for the preservation of injustice or for the extension of justice? In that dramatic scene on Calvary's hill three men were crucified. We must never forget that all three were crucified for the same crime--the crime of extremism. Two were extremists for immorality, and thus fell below their environment. The other, Jesus Christ, was an extremist for love, truth and goodness, and thereby rose above his environment. Perhaps the South, the nation and the world are in dire need of creative extremists.

I had hoped that the white moderate would see this need. Perhaps I was too optimistic; perhaps I expected too much. I suppose I should have realized that few members of the oppressor race can understand the deep groans and passionate yearnings of the oppressed race, and still fewer have the vision to see that injustice must be rooted out by strong, persistent and determined action. I am thankful, however, that some of our white brothers in the South have grasped the meaning of this social revolution and committed themselves to it. They are still all too few in quantity, but they are big in quality. Some -such as Ralph McGill, Lillian Smith, Harry Golden, James McBride Dabbs, Ann Braden and Sarah Patton Boyle--have written about our struggle in eloquent and prophetic terms. Others have marched with us down nameless streets of the South. They have languished in filthy, roach infested jails, suffering the abuse and brutality of policemen who view them as "dirty nigger-lovers." Unlike so many of their moderate brothers and sisters, they have recognized the urgency of the moment and sensed the need for powerful "action" antidotes to combat the disease of segregation. Let me take note of my other major disappointment. I have been so greatly disappointed with the white church and its leadership. Of course, there are some notable exceptions.

I am not unmindful of the fact that each of you has taken some significant stands on this issue. I commend you, Reverend Stallings, for your Christian stand on this past Sunday, in welcoming Negroes to your worship service on a nonsegregated basis. I commend the Catholic leaders of this state for integrating Spring Hill College several years ago.

But despite these notable exceptions, I must honestly reiterate that I have been disappointed with the church. I do not say this as one of those negative critics who can always find something wrong with the church. I say this as a minister of the gospel, who loves the church; who was nurtured in its bosom; who has been sustained by its spiritual blessings and who will remain true to it as long as the cord of life shall lengthen.

When I was suddenly catapulted into the leadership of the bus protest in Montgomery, Alabama, a few years ago, I felt we would be supported by the white church. I felt that the white ministers, priests and rabbis of the South would be among our strongest allies. Instead, some have been outright opponents, refusing to understand the freedom movement and misrepresenting its leaders; all too many others have been more cautious than courageous and have remained silent behind the anesthetizing security of stained glass windows.

In spite of my shattered dreams, I came to Birmingham with the hope that the white religious leadership of this community would see the justice of our cause and, with deep moral concern, would serve as the channel through which our just grievances could reach the power structure. I had hoped that each of you would understand. But again I have been disappointed.

I have heard numerous southern religious leaders admonish their worshipers to comply with a desegregation decision because it is the law, but I have longed to hear white ministers declare: "Follow this decree because integration is morally right and because the Negro is your brother." In the midst of blatant injustices inflicted upon the Negro, I have watched white churchmen stand on the sideline and mouth pious irrelevancies and sanctimonious trivialities. In the midst of a mighty struggle to rid our nation of racial and economic injustice, I have heard many ministers say: "Those are social issues, with which the gospel has no real concern." And I have watched many churches commit themselves to a completely other worldly religion which makes a strange, un-Biblical distinction between body and soul, between the sacred and the secular.

I have traveled the length and breadth of Alabama, Mississippi and all the other southern states. On sweltering summer days and crisp autumn mornings I have looked at the South's beautiful churches with their lofty spires pointing heavenward. I have beheld the impressive outlines of her massive religious education buildings. Over and over I have found myself asking: "What kind of people worship here? Who is their God? Where were their voices when the lips of Governor Barnett dripped with words of interposition and nullification? Where were they when Governor Wallace gave a clarion call for defiance and hatred? Where were their voices of support when bruised and weary Negro men and women decided to rise from the dark dungeons of complacency to the bright hills of creative protest?"

Yes, these questions are still in my mind. In deep disappointment I have wept over the laxity of the church. But be assured that my tears have been tears of love. There can be no deep disappointment where there is not deep love. Yes, I love the church. How could I do otherwise? I am in the rather unique position of being the son, the grandson and the great grandson of preachers. Yes, I see the church as the body of Christ. But, oh! How we have blemished and scarred that body through social neglect and through fear of being nonconformists.

There was a time when the church was very powerful--in the time when the early Christians rejoiced at being deemed worthy to suffer for what they believed. In those days the church was not merely a thermometer that recorded the ideas and principles of popular opinion; it was a thermostat that transformed the mores of society. Whenever the early Christians entered a town, the people in power became disturbed and immediately sought to convict the Christians for being "disturbers of the peace" and "outside agitators."' But the Christians pressed on, in the conviction that they were "a colony of heaven," called to obey God rather than man. Small in number, they were big in commitment. They were too God-intoxicated to be "astronomically intimidated." By their effort and example they brought an end to such ancient evils as infanticide and gladiatorial contests. Things are different now. So often the contemporary church is a weak, ineffectual voice with an uncertain sound. So often it is an archdefender of the status quo. Far from being disturbed by the presence of the church, the power structure of the average community is consoled by the church's silent--and often even vocal--sanction of things as they are.

But the judgment of God is upon the church as never before. If today's church does not recapture the sacrificial spirit of the early church, it will lose its authenticity, forfeit the loyalty of millions, and be dismissed as an irrelevant social club with no meaning for the twentieth century. Every day I meet young people whose disappointment with the church has turned into outright disgust.

Perhaps I have once again been too optimistic. Is organized religion too inextricably bound to the status quo to save our nation and the world? Perhaps I must turn my faith to the inner spiritual church, the church within the church, as the true ekklesia and the hope of the world. But again I am thankful to God that some noble souls from the ranks of organized religion have broken loose from the paralyzing chains of conformity and joined us as active partners in the struggle for freedom. They have left their secure congregations and walked the streets of Albany, Georgia, with us. They have gone down the highways of the South on tortuous rides for freedom. Yes, they have gone to jail with us. Some have been dismissed from their churches, have lost the support of their bishops and fellow ministers. But they have acted in the faith that right defeated is stronger than evil triumphant. Their witness has been the spiritual salt that has preserved the true meaning of the gospel in these troubled times. They have carved a tunnel of hope through the dark mountain of disappointment. I hope the church as a whole will meet the challenge of this decisive hour. But even if the church does not come to the aid of justice, I have no despair about the future. I have no fear about the outcome of our struggle in Birmingham, even if our motives are at present misunderstood. We will reach the goal of freedom in Birmingham and all over the nation, because the goal of America is freedom. Abused and scorned though we may be, our destiny is tied up with America's destiny. Before the pilgrims landed at Plymouth, we were here. Before the pen of Jefferson etched the majestic words of the Declaration of Independence across the pages of history, we were here. For more than two centuries our forebears labored in this country without wages; they made cotton king; they built the homes of their masters while suffering gross injustice and shameful humiliation -and yet out of a bottomless vitality they continued to thrive and develop. If the inexpressible cruelties of slavery could not stop us, the opposition we now face will surely fail. We will win our freedom because the sacred heritage of our nation and the eternal will of God are embodied in our echoing demands.

Before closing I feel impelled to mention one other point in your statement that has troubled me profoundly. You warmly commended the Birmingham police force for keeping "order" and "preventing violence." I doubt that you would have so warmly commended the police force if you had seen its dogs sinking their teeth into unarmed, nonviolent Negroes. I doubt that you would so quickly commend the policemen if you were to observe their ugly and inhumane treatment of Negroes here in the city jail; if you were to watch them push and curse old Negro women and young Negro girls; if you were to see them slap and kick old Negro men and young boys; if you were to observe them, as they did on two occasions, refuse to give us food because we wanted to sing our grace together. I cannot join you in your praise of the Birmingham police department.

It is true that the police have exercised a degree of discipline in handling the demonstrators. In this sense they have conducted themselves rather "nonviolently" in public. But for what purpose? To preserve the evil system of segregation. Over the past few years I have consistently preached that nonviolence demands that the means we use must be as pure as the ends we seek. I have tried to make clear that it is wrong to use immoral means to attain moral ends. But now I must affirm that it is just as wrong, or perhaps even more so, to use moral means to preserve immoral ends. Perhaps Mr. Connor and his policemen have been rather nonviolent in public, as was Chief Pritchett in Albany, Georgia, but they have used the moral means of nonviolence to maintain the immoral end of racial injustice. As T. S. Eliot has said: "The last temptation is the greatest treason: To do the right deed for the wrong reason."

I wish you had commended the Negro sit inners and demonstrators of Birmingham for their sublime courage, their willingness to suffer and their amazing discipline in the midst of great provocation. One day the South will recognize its real heroes. They will be the James Merediths, with the noble sense of purpose that enables them to face jeering and hostile mobs, and with the agonizing loneliness that characterizes the life of the pioneer. They will be old, oppressed, battered Negro women, symbolized in a seventy two year old woman in Montgomery, Alabama, who rose up with a sense of dignity and with her people decided not to ride segregated buses, and who responded with ungrammatical profundity to one who inquired about her weariness: "My feets is tired, but my soul is at rest." They will be the young high school and college students, the young ministers of the gospel and a host of their elders, courageously and nonviolently sitting in at lunch counters and willingly going to jail for conscience' sake. One day the South will know that when these disinherited children of God sat down at lunch counters, they were in reality standing up for what is best in the American dream and for the most sacred values in our Judaeo Christian heritage, thereby bringing our nation back to those great wells of democracy which were dug deep by the founding fathers in their formulation of the Constitution and the Declaration of Independence.

Never before have I written so long a letter. I'm afraid it is much too long to take your precious time. I can assure you that it would have been much shorter if I had been writing from a comfortable desk, but what else can one do when he is alone in a narrow jail cell, other than write long letters, think long thoughts and pray long prayers.

If I have said anything in this letter that overstates the truth and indicates an unreasonable impatience, I beg you to forgive me. If I have said anything that understates the truth and indicates my having a patience that allows me to settle for anything less than brotherhood, I beg God to forgive me.

I hope this letter finds you strong in the faith. I also hope that circumstances will soon make it possible for me to meet each of you, not as an integrationist or a civil-rights leader but as a fellow clergyman and a Christian brother. Let us all hope that the dark clouds of racial prejudice will soon pass away and the deep fog of misunderstanding will be lifted from our fear drenched communities, and in some not too distant tomorrow the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.

Yours for the cause of Peace and Brotherhood, Martin Luther King, Jr.

What Drives Scientific Discoveries?

2012-01-08T15:15:00.001-06:00

Why Ben Franklin invented the odometer.

Plain Talk: Virtuous minds + a hefty dose of curiosity lead to virtuous pursuits that result in relevant scientific discoveries.

Ever wonder how people end up making great scientific discoveries? I do. In my studies I've come to realize that though we applaud and immortalize the likes of Galileo, Edison, and Einstein, being a genius isn't the primary factor for infamy.

If you've read any biographies of these famous guys, you can't help but be inspired by their tenacity, their drive to dispel wrong judgments by others (e.g., "learning-disabled"), and their insatiable curiosity about the world. That's pretty common knowledge, I'd say.

But have you ever thought about how these traits require their journey be anchored in the quest for truth, for beauty, for what's right? Science is inextricably linked to an order of goodness, though we don't often think of it in those terms. There is a logic to the universe, and what great scientists do is intentionally decide to spend their time pursuing that logic to discover relationships between phenomena, and bring forth a deeper understanding of the world. What we do with that knowledge is also steeped in ethical language. Do we use nuclear knowledge for good or evil? How do we define good and evil uses of nuclear physics?

I want you to realize that the pursuit of science involves setting aside our drive to satisfy our own gluttony (however defined) and instead means working hard....day in, day out...to make the world a better place. Hopefully, we enjoy the process as well. There is something gratifying about pursuing good things. Good can gratify us very deeply. Gratifying ourselves superficially and neglecting others in the process is not, in the end, good. Superficiality of your concept of life and the meaning of 'good' will never lead you to making a lasting positive contribution to the world. For some, that idea of 'good' ends in suicide. You have to get outside yourself to experience the good I refer to.

Beautiful, indelible marks in the world are left by beautiful hearts and minds, and it is a beauty that is shared, that is connected, and serves others in a myriad of ways. Leave your mark. Be beautiful.

How the Concept of Perfection Drives Ideas of Health

2011-12-16T19:57:00.000-06:00

"It's perfect!"

Per-fect: [adj., n. pur-fikt; v. per-fekt]: Flawless, faultless, complete, excellent, blameless, exact, pure, without deviation, undefiled, conforming absolutely to an ideal.

Plain Talk: Unspoken ideas of a perfect world affect everything in our lives, including ideas of health. Where we get mixed up is in thinking that health is the ultimate perfection that we should aim for.

Ah, perfection...have you thought about how the concept of perfection is the standard for life? What do we think about as the measuring stick for choices? Studies of consumer behavior point indirectly to this idea of perfection. We shop, we look, we analyze, and we try to find what will most satisfy us with regard to beauty, quality, and utility. There is a quiet undercurrent in our thinking and living that houses the notion that there is a perfection to everything. It usually plays out like this:

The shop-a-holic: "It's not perfect, but it was on sale."
The ecstatic shop-a-holic: "It's so perfect for the party!"
The excuse-maker: "I'm not perfect. No one is."
To my OCD friend: "Hurry up! It doesn't have to be perfect."
The sufferer: "Someday there will be no more tears or pain."
The lover: "I love you."
The courtroom: "Do you promise to tell the truth, the whole truth, and nothing but the truth?"
The gift: "It's the perfect gift for her."
The teenager: "It's the bomb!"
Mathematician: "I have the answer."
The prayerful: "Forgive my sin."
Religion: God.

More often, awareness of perfection manifests as "should" and "ought". The way life should be, and the way others should treat us. Though we make allowances for ourselves and others because we know perfection is not possible in this life, we still hold it as the benchmark by which we compare everything else.

Just as in our moral lives, the concept of perfection drives ideas of health. And steering ideas in health is a combination of what abilities the research world has at hand to develop health into a more perfect state. All you need to do is peruse the health headlines in popular media. Researchers continue to map the human genome to find secrets in the DNA that we can tinker with to prolong life, annihilate disease, and improve the quality of living. We want to cure cancer, live longer, destroy depression once and for all, combat obesity, and have perfect children.

The perfection quest is, after all, what backgrounds the widely-used term, "health-related quality of life". Quality of life is an alias for our pursuit of perfection. Unfortunately, it ends in a relativized version of perfection, because of other factors in our lives that hinder perfection...hindrances like genetics, lifestyle choices, income, and the nature of our relationships with friends and family. Quality of life, in its perfected form, would be described as peace and purpose. A health-related quality of life, therefore, is based on an abstract perception of perfect health.

Where I take issue with the idea of health-related quality of life is that happiness, peace, and purpose are equated to health. Just look at the TV commercials for health products that promise vibrancy, bounce, energy, longevity, sexual ecstasy, and love! Health is big business, and money is pouring in for these promises of the intangible positives that health seems to promise but can't deliver.

Questions for you:
1. How is that we have this innate idea of perfection? How is it that we are able to perceive the idea of perfect health, perfect life, perfect love, perfect family, perfect self, perfect peace, and perfect truth?
2. How does health-related quality of life affect personal peace and sense of life purpose? Is it possible to have a poor health-related quality of life yet still experience personal peace and life purpose? If so, how? If not, why not?

http://dictionary.reference.com/browse/perfect
http://en.wikipedia.org/wiki/Perfection

Orphans Have DNA Changes from Lack of Nurturing - A Clue to What it Means to be Healthy

2011-12-10T18:32:00.001-06:00

Plain Talk: When children are deprived of love, it affects their DNA, immune system, and brain function! The implications of this for understanding health are astounding!

Yale School of Medicine (article here) has discovered that a lack of nurturing in orphans induces epigenetic changes in DNA that weaken the immune system and adversely affect brain development and function.

If that doesn't astound you, then you haven't thought it through. Lack of love causes changes at the genetic level that result in weakened bodies and minds. That alone should blow your mind. Human beings are creatures made to thrive on love. Who are the most contented people, regardless of disability level? Those who are loved, who have purpose in life, and find meaning in life...meaning that includes generosity to others...love.

You should be thinking now of what that means for health research, health interventions, and health policy. If ever there was a call for health scholars to lobby for money for well-being research, this is it. And if ever the was a reason to advocate for infants and children, this is it.

For an intriguing look at epigenetics, read this article from TIME, "Why DNA Isn't Your Destiny" ...A great read!

A Poor Fit: Equating Well-Being with Alleviation of Vulnerability

2011-12-10T18:01:00.005-06:00

Plain Talk: Well-being is not equal-being. Attempts to equalize income and opportunities for all people ignore the life-sustaining necessity of being in loving relationships, a fact being borne out in the physiological research. Healthcare researchers should focus more on this dimension of health.

"Vulnerable populations"

"Health disparities"
"At-risk"

These are the designer catch-phrases in modern health. The problem, as I see it, is that vulnerability is such a broad term that can mean anything from extreme deprivation to normal life events experienced by all people, like loss of a parent. Bottom line is that everyone is vulnerable in different ways at different times. The current paradigms of health, while claiming to be focused on well-being, actually only advocate meeting physical and psychological needs.  When vulnerability is so defined, then only the poor qualify for the remedy, because only the poor have been assigned vulnerability status.

Does that strike you as odd? It does me. Since when are only the poor vulnerable? The wealthy are also vulnerable, but in less visible ways. First of all, there is not much research on vulnerability of the wealthy.  Using a scholarly search engine through a library, there was only 1 hit for "vulnerability of the wealthy" compared to 89 hits for "vulnerability of the poor".  Psychological research and Gallup polls tell us over and over that well-being of people does not vary that much over income levels once life's most basic needs are met. This is true across the world. It's because peace and purpose are not dependent upon equalizing socioeconomic status.

It's true that income correlates with longevity. Here's the rub: Somehow we have come to equate longevity with well-being. Is this true? Is long life the mark of a life well-lived? The well-lived life is not a life lived long!  Naturally, most people hope to live a long life. But they want a long, happy & satisfied life. People seek peace and purpose. Those that don't experience it may consider suicide.

There is a need to match the FIT between what it means to be human and what it means, ultimately, to be healthy. We have to move beyond vulnerability thinking, move past the idea of the "multi-problem poor", to the bigger picture of what it means for people to live in harmony with themselves and those around them. This is the life people consider as "well-being"...that sense that even during adversity and vulnerability, they still stand strong...and more often than not, that involves a social network of "relational belonging"...or, more simply, love.

Rate the well-being and vulnerability of these two people:
Bob, age 44, is a millionaire several times over, divorced, has no close friends, and has contemplated suicide, despite the fact he could buy anything he wanted.

Frank, an 86 year old widower, barely makes enough to meet expenses, has a close-knit network of family and friends, volunteers his time, has found meaning in life's adversities, and is thankful for his life.

Or consider this true-life example: J. Paul Getty, one of the richest men in the world said, “I would gladly give all my millions for just one lasting marital success.” This from a man who was married 5 times.

Well-being should never mean the same as alleviation of vulnerability. If it does, then we do not understand what it means to be human beings...beings for whom thriving means acceptance, affirmation, belonging, and loving. Thriving is not realized in self-isolation. Thriving is found in "relational belonging"...or love. And love can occur alongside vulnerability, and is capable of disarming many forms of vulnerability, according to the latest neurophysiological research.

What do you think?

If you're interested, here's the results of my Google search. Notice how both vulnerabiltiy and well-being are assumed to be related to income.

Google search results on vulnerability:

vulnerability and poverty - 22,500,000
vulnerability and wealth - 11,100,000
vulnerability and low income - 8,780,000
vulnerability and high income - 3,400,000

Google search results on well-being:

well-being and poverty - 163 million
well-being and wealth - 180 million
well-being and low income - 114 million
well-being and high income - 141 million

For the most exhaustive scholarly research on well-being, check out Ed Diener, psychologist, who has been researching this for 30+ years and has 300+ publications on the topic. http://s.psych.uiuc.edu/~ediener/

Rethinking Health Paradigms

2011-09-20T22:56:00.005-05:00

Plain Talk: Thinking outside the box might mean that we're really talking about something else...something besides the box. We're questioning all the conventional assumptions.

"Society shuns what society celebrates".*
How true. We celebrate love, community, sacrifice for others, virtues, strong convictions in tandem with those esteemed virtues yet on another level we despise virtues and value our independent selves above community. Where does healthcare focus its interventions? On the SELF.

What's wrong with us? In thinking about our philosophy of health, shouldn't the litmus test for where we should place our healthcare dollars be grounded in what we value in our societal celebrations? Rather than focus health interventions solely on the self, shouldn't it also be on how we, at the individual level, interact with the community at large? Shouldn't it be in what we celebrate, like virtuous living characterized by love and unselfishness and giving? YES!

So rather than go with the status quo of independent enablement for health, what would happen if we assumed responsiblity for each other, beginning with love and social responsibility, those things that create health-enabling endorphins and other positive physical effects? What would change?

Am I crazy? YES!
Is it right? I'm sure of it.

We need to not only think outside the box, but question if what we're in is really a box, after all.

*Scott Belsky, CEO, Behance.

How to Write a Nursing Philosophy Paper

2011-09-15T22:31:00.002-05:00

Assignment: Write a 10 page paper on nursing philosophy. Expound how it relates to the theorist of your choice, the nursing metaparadigm, and implications for nursing practice.

Could anything be more painful? Or boring? Or seemingly unimportant and irrelevant? Really....is this going to be of value doing CPR on your patient who just coded from a drug overdose? How do these nurse academicians think up this stuff, anyway? That's what I used to think, too.

Set those thoughts aside. Negativity is of no help to you now. Nursing philosophy and theory IS important. That's why your professor created the assignment. Don't let the unfamiliarity of it scare you off. I'll help you with it.

Reality: The paper is 25% of your grade.

PLAIN TALK: Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like. So philosophy affects both the beginning and end of nursing actions. It explains why you do the things you do, and why you do them in the way that you do them.

Let me help you tackle it. These assignments are so often way too broad and extensive, mainly because professors often don't appreciate the enormity of what they're really asking. The one thing that helps the most is to imagine how you would explain to a friend why you went into nursing, what "health" is, and what nursing should "look like". In this case, you're explaining it to your professor. Here's how to do it:

1. Break down the assignment into its basic elements:

A. Personal philosophy of nursing. See my prior blog post on this topic.

B. Metaparadigm: Nurse, patient, environment, health. Although this is taken as written as stone, you may, like I, not fully agree. But accept it for now. Changing metaparadigms is a lot of work.

C. Definition of nursing. The most widely accepted definition is the American Nurses' Association definition.

D. Theorist of choice. This often depends on the type of patient you're caring for. No one theory works for every setting. So state up front what kind of patient you are thinking of and that will direct your choice of theory. Write in your paper that no one theory works for everything. Justify why you have chosen that particular theory for that particular kind of patient and that particular kind of nursing. For example, a post-op orthopedic patient fits well with Orem's self-care theory. Care of the chronically ill/diabetic Hispanic patient is a nice fit for Leininger's transcultural theory. The newly divorced patient or newly widowed patient fits with Meleis' transitions theory.

2. Another element you need to think about is your philosophy of health. Nobody ever talks about this. You need to think about what is health? It's not necessarily the nursing metaparadigm. Read through this blog to get more ideas. Come to your own conclusions. You need to state your beliefs about health.

3. Once you've decided on the elements above, you need to figure out how these elements relate together. The most common error is to try to say everything about every element. That ends up a bloated, overwritten, blob. Pick one small area of each element and link it logically to all the other elements. For example, maybe you center it all on a hypothetical patient. Maybe you will focus on the generalities of a quality of nursing, like caring and show what that looks like at each level.

What you are doing is building a pyramid. The bottom layer is your philosophy. The next layer is the nursing metaparadigm, then the theory, then nursing practice, then the particular patient where one-on-one nursing occurs. Your job is to connect the dots from one layer to another.

Remember: Your philosophy, which is just a fancy name for your beliefs and values and WHY those are your beliefs and values, is what guides your selection of theory and how you envision what effective and good nursing looks like. So philosophy affects both the beginning and end of nursing actions. It explains why you do the things you do, and why you do them in the way that you do them.

Good luck. You'll do fine. Let me know how I can help.

This is Why Nursing Philosophy is Hard

2011-09-11T15:11:00.004-05:00

Plain Talk: Google's search engine confirms it: Philosophies of health don't really exist. And they should. They must if nursing is going to advance in its philosophical work. That's the only way healthcare will advance past the current models.

The Details:
Nursing philosophy is hard because most of the time what is being referred to is not nursing philosophy, but health philosophy. The professor assigns the nursing students the ever-elusive, most hated assignment: "Write a 5-10 page paper on your nursing philosophy, undergird it with theory, and demonstrate how it is implemented in the four domains of nursing (nurse, patient, environment, health), and justify your reasons for your position." This is literally an impossible assignment. Volumes have been written on these subjects. It cannot be addressed in a short paper. The single revelation here is that even professors don't understand it. I don't fault them, though, because our discipline has not adequately pursued the development of philosophy.

I've realized over the last few years, though, that the main difficulty lies in the fact that we have not adequately stated a philosophy of health. With all the various interpretations and dimensions of health discussed in nursing, psychology, medicine, and sociology, we are still missing something. I think that "something" is found in our presuppositions...our fundamental beliefs and assumptions that guide our view and interpretation of the world.

The quandaries of the nursing philosophy assignment is a clue to the fact that we don't have it quite right. Look at how nursing views "health": physical, emotional, spiritual, environmental. It's a modular idea. We took the medical paradigm of the body's mechanical functioning, glued on emotional and spiritual dimensions, and set it against a backdrop of environment. When all systems are "go", we want to call it "health" or "energy" or "being". Even integrative medicine that emphasizes nutrition, stress reduction, and exercise are generally based on a modular approach.

If nursing is going to make sense of nursing philosophy, it needs to consider philosophies of health. The current philosophy of health as stated in the paragraph above is inadequate. Before we can be prescriptive (make recommendations for people's health) we must be proscriptive (describe what health is & is not). Since health has come to mean more than the physical, and more along the lines of human flourishing, then we have to figure out what constitutes human flourishing.

Enough for now.

(Photo source: Research Haven)

Moving Towards an Altruistic Health Paradigm

2010-08-21T22:51:00.014-05:00

Plain Talk: Love, Significance, and Human Dignity are central to understanding health. These are not just niceties but critical to life.

The Details:
The Altruistic Health Paradigm is the result of fine-tuning the Perspectival Evidentialism model into a broader application. While the Perspectival Evidentialism model describes a pragmatic process of nursing, the beauty of this model is the adaptability to an altruistic health paradigm. The simplicity of the model allows adaptation at a myriad of levels from societal contexts of health philosophy to individual contexts to ethical contexts. It's really versatile and flexible for speaking of the paradigm's three perspectives at any level, for any population, and for any culture.

What I'm working with right now is rudimentary. I have taken the three perspectives (Normative, Existential, and Subjective) of the model and, after much thought, have decided that the best representation of ultimate human purpose and fulfillment is most aptly characterized by the following:
1. Normative (law, ethic) = Love
2. Existential (I, me, self) = Human Dignity
3. Subjective (others, situational, relationships) = Significance

Coherent discussion of each perspective (love, human dignity, and significance) is fundamentally dependent upon the other two perspectives. Indeed, it is very difficult, if not impossible, to discuss each perspective independent of the other two perspectives.

This Altruistic Health Paradigm is, I feel, what truly comprises nursing philosophy, though nursing philosophies usually stop at "mind-body-spirit" and call it holism. I'm not sure why in healthcare we avoid talking about the great ethical and practical foundation of love, yet we miss the bigger picture when we do so. Perhaps it seems so intuitively right that nursing philosophers felt that no more explication was necessary. Certainly, the most similar word used in nursing has been compassion. While 'compassion' is related to love, no other word or concept can truly suffice for "love".

We need to articulate the redemptive aspect of healthcare that we are after, and the ultimate is not healthy systems, but a healthy person with purpose and passion who is infused with dignity, significance, and love. It is human flourishing. I am keenly aware that using "love" may confer some namby-pamby sentiment but that level of meaning is very shallow and illusionary at best. Love in the ultimate sense is anything but that. Love in the ultimate, redemptive sense is that which seeks the best in and for another person and enables them to achieve it not only for their own sake, but for the sake of others.

Why "Mind, Body, & Spirit" is an Inadequate and Constrictive Framework

2010-05-23T16:03:00.025-05:00

Plain Talk: Thinking of health as mind-body-spirit, while useful, in its own right, leaves out the importance of meaning and purpose that we know we are made for. We have to include this when we think of health.

The Details:
No nurse (at least in the western world) sees nursing as "just" caring for the sick, the babies, and the old people. Heaven forbid. Hopefully, we've come much farther than that. But we have much farther to go, in my opinion.

If I asked you to tell me how nursing is different than medicine, you'd probably offer that medicine is disease-focused, and nursing is holistic, and by that you would mean that nursing considers the "whole" person. You would describe to me that people are not just bodies, but also made of a unity of body, mind, and spirit. Nurse scholars have offered similar concepts. McEwen &Wills (2007) put it this way: "Person refers to a being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his parts." (p. 43).

We'll come back to this.

Next, consider the objectives of the nursing profession: care of the sick, care of the well, assisting self-care activities, helping people attain their human health potential. McEwen &Wills (2007) continue: "The purposes of nursing care include placing the client in the best condition for nature to restore health, promoting the adaptation of the individual, facilitating the development of an interaction between the nurse and the client in which jointly set goals are met, and promoting harmony between the individual and the environment. Furthermore, nursing practice facilitates, supports, and assists individuals, families, communities, and societies to enhance, maintain, and recover health and to reduce and ameliorate the effects of illness." (p. 43).

I hoped you picked up on the common bond between these well-accepted explanations of person and of the purpose of nursing. The commonality is that of a systems framework. When man is conceptualized as a system, then any nursing interventions will necessarily be systems-oriented, if nursing is to be at all congruent with their philosophical foundations. But for reasons I'll discuss below, I think this is a thoroughly short-sighted framework that has squelched the work of nursing, at least theoretically speaking.

At the risk of sounding disrespectful, one can pretty easily substitute "dog" (especially a smart dog like mine) in the above definitions and have coherent statements. I'm not saying nurse scholars through the ages think of humans as mere systems. It's obvious they don't think that. I definitely appreciate the great difficulty that arises in finding adequate language to describe the nature of man. That's been the plague of philosophy for ages, after all.

But is there a more robust conceptualization of man and by extension, nursing, that will take us beyond this constrictive framework of "mind-body-spirit"? I believe there is. Indeed, nurse researchers have come close to it in their studies on hope.

What I am proposing is a re-conceptualization of man within nursing philosophy that places the focus on vision, passion, and purpose of the individual. This new paradigm more rightly aligns "health" with the true nature of man. Health is not a repair schedule in which "systems" are fixed and fiddled. Health, true health, is when people possess a passion for the purpose of enriching the lives of others and themselves by virtue of a higher vision for a meaningful life that reaches outside themselves to others in goodness. This is the only explanation offered by say, a patient with terminal cancer, who is consumed not by cancer, but is consumed with life purpose. This vision and passion I speak of is akin to hope but not the same as hope. I think passion is much deeper than hope and I think it is more representative of how we would describe true health. It is a passion fueled by virtue.

As nurses, if our calling is to direct patients towards true health, then our focus cannot solely be on a systems orientation. The absence of physical (system) illness is not true health. The absence of mental (system) illness is not true health. The absence of emotional (system) illness is not true health. The absence of spiritual (system) distress is not true health. A "working" systems paradigm cannot constitute true health, because we are not, fundamentally speaking, a set of systems.

We must look far beyond the confines of systems paradigms. Is it possible to instill a sense of vision, passion, and purpose in our patients? Of course it is. The opportunities are immense. This is a huge field ripe for some creative and scholarly research focused on optimizing the individual to live a life of importance, of service, of love.

Lack of purpose robs. Lack of passion starves. Lack of vision kills. We were not made for ourselves only...such thinking is destructive to our souls and bodies. Think how much "healthier" we would all be if we just had a megadose of vision, passion, and purpose to benefit others and truly impact our world.

The new metaparadigm for true health:
Perceive the vision.
Possess the passion.
Pursue the purpose.

See.
Feel.
Live.

Stay tuned. More to come as we flesh this out little by little and see how it fits within the Perspectival Evidentialism model. Let me know your thoughts.

McEwen, M. and Wills, E. M. (2007). Theoretical Basis for Nursing. 2nd ed. (Philadelphia: Lippincott Williams & Wilkins.

New Thoughts on the Supposed Theory-Practice Gap

2010-02-15T13:33:00.019-06:00

Plain Talk: Maybe we don't have a theory-practice gap. Instead, we may have a gap between the way we think of human nature and the questions we come up with for nursing research. How we understand human nature will necessarily impact what we choose as nursing research topics. We have not spent enough time in nursing developing the concept of human nature as it relates to health.

The Details:
Green, Catherine. (2009). A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy 10(4), 263-274.

Ontology: the study of what exists, what is real.

I applaud this article. Catherine Green notes that our source of knowledge of others is our observance of a person’s intentional actions. Green acknowledges the stances of two philosophers, Wallace and Sokolowski.

Wallace states that personal responsibility for choices is ingrained in our relationships with others and society.

Sokolowski asserts that personal intentionality is made known publicly by one’s actions.

If we blend Wallace and Sokolowski into one statement, it would be this: We have knowledge of other people based on their choices and these choices reflect their intentions. At this point, you might be thinking, “duh”. Keep reading.

Green uses this synthesis to suggest this might help close the theory-practice gap. But I think it’s deeper than that. To me, Green’s article reveals that the problem is not a theory-practice gap so much as it is an ontologic-research gap.

The theory-practice gap is the ‘disconnect’ that some have noted as the mismatch between theory in the classroom and real-life nursing practice. Who thinks about Roy, Orem, Nightingale, Rogers, Henderson, etc. during daily work? Some of these theoretical systems are very complex. But maybe that’s not the REAL problem.

The real problem, I think, more often lies in the ontologic, which I’ve written about before. In nursing practice, we’re not dealing with a theory, we’re working with a person. So our assumptions about the nature of man must be accurate for us to effectively intervene on their behalf. We do this instinctively. The reason theory doesn’t resonate with us may be because the theory reflects dimensions of man, rather than ontology of man. Theory recognizes domains of man as social, physical, mental, and spiritual being. But deeper than that is man’s morality and intentionality, as Wallace and Sokolowski asserted.

Ideally, philosophy informs theory which informs research which informs practice.

Skipping philosophy to focus on theory and then jumping to practice creates some potential problems. Problems like treating theory as if it were the philosophy. A poorly articulated philosophy/ontology will result in a tenuous theory, which down the road finds a disconnect to practice.

Green has it right. The ontologic notions of relationship, revelation of personal intention, and moral responsibility that Green so aptly describes is premised on the belief that nursing theory needs a more ontologically sound foundation. Indeed, an ontologic focus on man’s essential being is necessary if we are to extract pertinent research questions about the essence of man’s well-being. By defining the nature of man more thoroughly, nursing theory is built on a more solid foundation. Following suit, the research is targeted to truly pertinent questions, and practice naturally follows in accordance.

Green’s pragmatic emphasis echoes the work of Doane and Varcoe (2005) who adopted a nursing philosophy of pragmatism, which is a process to “bring knowledge, compassion, and action together to produce practical knowing – to develop knowledge in service of worthwhile human purposes” (p. 115). I assert that such practical knowing is steeped in the ontologic primarily, and in the theoretical secondarily. Green’s work is a step in the right direction.

I’m not saying my opinion is revolutionary or the be-all, end-all. I think we need to get out of the rut of always assuming there is a problem we call the theory-practice gap. Maybe it’s not that at all in some cases. Maybe it’s an ontologic-research gap.

I propose that the next step forward involves exploring this ontologic synthesis of man as a relational and intentional being.

Listen to Sokolowski: “What human nature is capable of being in its actions is shown not primarily by philosophical speculation but by good human agents. Virtuous action in concrete situations is the primary display of the possibilities of action…Virtuous agents acting are the measure of what ought to be done. There is no cognitive substitute for this original display.” (Sokolowski, 1985, p. 149).

References

Doane, G. H. (2009). Toward compassionate action: Pragmatism and the inseparability of theory/practice. In P. G. Reed, Perspectives on Nursing Theory (5th ed., pp. 111-121). Philadelphia: Lippincott, Williams, and Wilkins.

Green, C. (2009). A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy , 10 (4), 263-274.

Sokolowski, R. (1985). Moral Action: A Phenomenological Study. Bloomington IN: Indiana University Press.

Portions of this post were selected from my letter to the editor of Nursing Philosophy, publish date pending.

Nursing Theory is SUCH a Dog!

2010-02-12T23:34:00.006-06:00

(This was an impromptu writing to fulfill a short assignment on metaphors for nursing theory.)

I'm sitting at my computer, gazing at my 10 year old arthritic black and tan female German Shepherd, Jala, who is sleeping three feet from me with her muzzle cradled on her right paw. A distant child's voice from outdoors sparks her from slumber. Ears upright, a turn of the head, a quick glance towards me, and she lazily rolls onto her side. It's only a child. No worry.

For ten years she has exercised faithful vigilance over the theoretical unknowns. New interpretive contexts fall somewhere between Jala's creative independence and learned boundaries. Like letting babies crawl on her. Or assuming a sentry position outside doors of dreaming toddlers. Or testing new relationship constructs by "telling" me the cat need to go out. Or experimenting with new applications: Will she be allowed to take Vail's place in bed while he is out of town?

We have not yet discovered any interpersonal environment to which she cannot adapt. Her concepts have stood the test of time. As an interdisciplinarian with Kuhnian tendencies, this 4-legged, 90 lb. holistic framework must perpetually assess the neighborhood for new evidence that might invoke a paradigm shift. The research continues to support Jala's fundamental assumption that a healthy and safe environment is the criterion of community wellness.

Nursing theory is such a dog!

Developing a Personal Nursing Philosophy

2010-01-31T21:01:00.017-06:00

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Every discipline has its philosophical foundation, and nursing is no different. Philosophy attempts to answer the questions of what nursing is, why it exists, and what ethics and values underpin these beliefs. Inherent in any nursing philosophy is how man is conceptualized. If you are new to nursing philosophy, this is where I would recommend you begin in identifying your own philosophy of nursing.

Nursing philosophy, like any other discipline-specific philosophy, is what directs and drives research and knowledge development to advance the discipline. Philosophy, then, articulates the core beliefs of a discipline and defines the boundaries of what we want to know about our discipline.

Your personal nursing philosophy is not your treatise on why you want to be a nurse. It is not a statement about what nurses do in context of health and illness. If that is where you're at right now, you need to drop down a level, because what nursing "looks like" must be undergirded by why it should look like that (whatever "that" is). You are trying to explain to someone else why nursing exists. Go deeper than the superficiality of "nursing helps people maintain health" or "nurses alleviate suffering". Incessantly ask yourself "why". Get past the superficial.

Philosophy is formed from intuitions and beliefs about the way life should be and why you think it should be that way. You should consider the following questions when you write your personal nursing philosophy:

1. What is the purpose of man's life? Why do you believe what you believe?

2. Why do people value health? How does health relate to man's purpose?

3. How does illness interfere with our purpose in life? Or does it?

4. How do you define health? How is that related to your idea of man's purpose in life?

5. What do you believe about the community of man? What are our social obligations to our fellow man? Why?

6. Is "health" a right? Or is it an ideal? Is medical care a right? Or is it an ideal?

7. By now you should have an idea about what ethical values you think should be held by nurses. Again, this is related to your concept of humanity and our purpose in life.

8. If you get stuck anywhere along the way, keep asking yourself "Why do I believe this?" and you'll eventually get there, though it can be mind-boggling at times. You'll find that your answers always revolve around values and morals and purpose. That's why it's important to know what you believe and why. Keep asking these questions of yourself.

By working through these questions you will arrive at how nursing fits into your philosophy of man, because your philosophy will reflect what you believe about yourself, and it should also lead you to why you chose nursing as a profession.

Philosophy can be intimidating, but it is just a fancy term for your beliefs and your justification of those beliefs. Good luck! Email me with your questions. I'd also love to read your philosophy! pamelafruechting@gmail.com

Nanotechnology: Re-Thinking Nursing Philosophy

2010-01-26T11:47:00.015-06:00

We are on the brink of catapulting healthcare into one of the most fascinating discoveries of science: Nanotechnology. The coming technology (in progress now) will exceed anything we ever thought possible a couple of decades ago. Before we go any further, though, a simple description is in order.

From Wikipedia:
"One nanometer (nm) is one billionth, (or 10 to the −39th), of a meter. By comparison, typical carbon-carbon bond lengths, or the spacing between these atoms in a molecule, are in the range 0.12–0.15 nm, and a DNA double-helix has a diameter around 2 nm. On the other hand, the smallest cellular life-forms, the bacteria of the genus Mycoplasma, are around 200 nm in length."

From Allhoff, et al (2007): "If a nanometer were somehow magnified to appear as long as the nose on your face, then a red blood cell would appear the size of the Empire State Building, a human hair would be about two or three miles wide, one of your fingers would span the continental United States, and a normal person would be about as tall as six or seven planet Earths piled atop one another."

So we've established that nanotechnology occurs on an astronomically small scale. At this level, everyday materials have extraordinary properties. For instance, carbon nanotubes are one of the strongest materials known, up to 100 times stronger than steel, and one-sixth the weight (Allhoff, et al, 2007).

Applications of nanotechnology include: molecular robots (nanobots) implantable into the human body to monitor and modify physiological functions, disease modification, drug delivery, enabling cellular repair, counteracting the aging process, nano-level surveillance cameras for government use, nano-warfare, bio-warfare, and polluting or purifying water and food sources, just to name a few. The waste products of nanotechnology have the theoretical potential to induce disease, and so environmental concerns are emerging. Studies are ongoing to determine the true risks.

One particular nanobot application is incredibly amazing: Brain computation and capacity. The human brain has a hundred trillion connections, and calculates at 1026 calculations per second. Brain implants will be capable of enlarging our memory a trillion-fold as well as improve sensory input and cognitive abilities (Allhoff, et al, 2007). The implications of wireless networks running our brains (or part of them) causes certain questions to emerge surrounding the topic of personhood. Is our personhood determined by who we are without enhancement or with enhancement or both?

These coming changes in the next two-three decades should compel to us to consider the urgency of the ethical, social, philosophical, and religious implications. Already the city of Berkeley, CA, is a step ahead and is developing regulatory policy on nanotechnology.

So what's the link to nursing philosophy? The link is both conceptual and practical:

*How will nanotechnology alter our perception of "person"? Or will it?

*How will our concept of "health", "disease", and "wellness" change with the inevitable nanotechnology applications?

*Will new nursing theories be necessary? In what way?

*How will the basic meanings of nursing change? Or will they?

Think about it and wrestle with it. Bring it up with your colleagues and fellow students. Let me know what you think.

1. http://en.wikipedia.org/wiki/Nanotechnology. Accessed January 26, 2010.
2. Allhoff, F., Lin, P., Moor, J. & Weckert, J. (2007). Nanoethics: The Ethical and Social Implications of Nanotechnology. Hoboken, NJ: John Wiley & Sons.

Perspectival Evidentialism ©

2009-05-23T14:18:00.045-05:00

(Satellite photo of the world at night)

Perspectival Evidentialism ©.
Kind of a mouthful, isn't it?

Plain Talk: These ideas demonstrate how we might picture human nature a bit differently compared to body-mind-spirit yet still accounting for body-mind-spirit. A perspectival view accounts not only for the patient, but also the nurse, social networks, values, and environmental aspects and how all these impact the person as a whole.

The Details:
How about a preview?
This is the name I've chosen (for now, anyway) for my philosophy of nursing. I think "perspectival evidentialism" is a good fit because the term itself embraces the simultaneous elegance of reality's simplicity and complexity while permitting evidential evaluation of the whole of man's well-being. This is the backdrop against which nursing epistemology and, by logical extension, nursing science rests. In a definite but more general sense, it is a philosophy of nursing based on human ontology of ethic, being, and doing. The beauty of this is that both client and nurse stand together in a holistic interchange. In other words, because of the perspectival reality we all live in that is comprised of ethics (which reflect our beliefs about truth), personal relationships (even including society as a whole), and our own existential being, both nurse and client are always interdependent.

I offer here a very simplistic overview of Perspectival Evidentialism:
Envision a 3-D triangle.

The perspectival component entails three perspectives (the angles of the triangle) of human ontology...three lenses, if you will, through which we develop nursing science: Normative (i.e., truth, beauty and ethic), Existential (the self, I, me), and the Situational (relationships, environmental factors, anything outside of "me").*

Each perspective is just that: a view of the problem or situation from one perspective, but it is a view of the WHOLE in its entirety. The model is inseparable, non-linear, non-hierarchical. It is an integrative whole. It is NOT like that old parable about 3 blind men's interpretations of what an elephant is like, because in that parable each interpretation is actually an interpretation of a PART, which is more of a "systems" framework.

The evidential aspect refers to the "evidence" revealed by each perspective, such as a particular ethical or truth problem, a situational problem (relational, social justice, environmental, economic), or an existential problem (self-identity, self-purpose, personal desires, lack of knowledge).

I want you to think about this evidential aspect. Consider:

1. If you are a nurse, you stand in the middle of these triangulated perspectives (normative, existential, and situational) as a perspectival interpreter: to the client, to the profession of nursing, and to society, with the ultimate purpose to maximize the holistic health of mankind based on a knowledge of biobehavioral motivations.

2. It is the nurse who assists the client existentially in interpreting the knowledge (scientific or ethical or relational) available at the given moment and who upon proper assessment of the interplay of the perspectives, offers a plan of care to optimize the holistic fulfillment of the client in keeping with truth (scientific, ethical, relational).

3. It is the nurse who stands in the public arena of social justice to destroy barriers that enable disparity. These barriers are seen as roadblocks to holistic health because we interpret them as unethical, whether we are talking about laws, medical access, or economics. We are constantly measuring issues relative to the perspectival model, whether we realize it or not. We adjudicate on the basis of our understanding of truth, the reality of man, and the nature of man's relationships. In the end it all boils down to a battle of truth. That doesn't mean, however, that truth is always easily discerned.

4. It is the nurse who takes notice of the biobehavioral responses of the client (the existential) relative to his situation (environmental and relational) and relative to truth (scientific and ethical). Nursing research/science is thus borne from these biobehavioral observations.

Perspectival Evidentialism is broad enough for transglobal application yet readily adaptable to the narrowest client problem conceivable. I believe its success as a nursing philosophy is rooted in its description of human desire and its constant quest for balance of ethics (truth and beauty) and relationships (interpersonal and environmental relationships). The willful choices of man relative to his desires are the "evidence" of his holistic state (at any given time) and "evidence" of the influence of the related perspectives. Think about that. We constantly interpret our world within these perspectives, and then act on our strongest desire at that moment.

"Evidence-based practice" just took on a greater meaning. Do you see that? Perspectival Evidentialism forces us to analyze the evidence of man's self and his desires; the evidence of truth, ethic, and beauty; the evidence of relationships. The nurse as interpreter of "evidence" then refines and hones the nursing knowledge ("evidence") discovered through nursing research/science, then stands again as interpreter (translator, disseminator) of evidence to the client.

I believe the Perspectival Evidential model holds promise for framing nursing science within a truly holistic sense at the most fundamental ontological level of personal desire, intention, and purpose. I believe it will enable us to speak more cogently, concisely, and coherently about holistic health within the current catch-phrase of "evidence-based practice". The beauty of Perspectival Evidentialism is that evidence-based practice can now encompass holism without the sacrifice of empiricism, rationalism, or subjectivism. Indeed, holism requires all these and then some.

Perspectival Evidentialism © is a model of revelation (of what we know or believe to be true) whereby examination and research that is guided by a truthful ethic, facilitates nurses to intervene therapeutically for clients (whatever form that might take: physical, emotional, intellectual, spiritual). Kind of like a holistic GPS. :-)

*(I had envisioned this model in rudimentary form about three years ago. Much to my delight, John M. Frame had created and exposited this same perspectival model. His book, The Doctrine of the Knowledge of God (1987, P&R Publishing), is a philosophical and theological argument for the model. I am indebted to Dr. Frame for allowing me to adapt this model for nursing philosophy. E-mail correspondence 01-23-08.)

Truth and Beauty

2009-05-08T06:18:00.025-05:00

“Beauty is a very successful criterion for choosing the right theory...a beautiful or elegant theory is more likely to be right than a theory that is inelegant.”

(Murray Gell-Mann, 1969 Nobel Prize in physics, renowned for his work on elementary particles, namely quarks...which he named.)

Truth and beauty. Inseparable. One and the same.

The evidential power of beauty is in its truth, its order, in the fulfillment we experience when we perceive it. We were made to crave the ecstatic beauty of the world, of relationships, and the truth that permeates every iota of it. We desire to be astounded by an elegance that defies description...an elegance that is necessarily characterized by timeless truth and goodness.

Ultimate beauty owns truth, ethic, and order. Chaos is not an expression of beauty but its very antithesis. Ugliness is not a relative beauty, it is a violence against beauty.

Does it surprise you that physicists ascribe truth to beauty? The thrill of the profound escapes the boors who stupidly believe the age-old caricature of scientists as a group of boring intellectuals who seemingly have nothing more interesting to do than complex equations. Truth is, the boors live in a pitifully bankrupt superficiality.

There is an objective beauty that we necessarily desire and pursue to delight us, enthrall us, and enrapture us. I think physicists are a lucky lot...their profession spans the subatomic to the cosmologic...how could they ever deny the truth of beauty...they live with it daily. And so do you, if you take time to ponder. The satisfaction that only ultimate beauty and truth can fulfill is the pleasure we desire most above all else, though we often search for it in the wrong places. Man's quest is to be consumed by a lasting and purposeful passion that brings meaningful balance and import to life. I dare you to deny you seek the same .

So what's my point, you may ask, as it pertains to nursing philosophy. The point is this: everything. Any nursing philosophy must, without question, simultaneously possess and reflect truth and beauty, and the relentless human longing for it. If it doesn't, well, then I'd say it's ugly. Give it some thought. Dwell on what is beautiful, truthful, and right. Dwell deep.

The Value of Philosophy

2009-04-23T12:12:00.009-05:00

“…it [philosophy] keeps alive our sense of wonder by showing familiar things in an unfamiliar aspect."

(Exploding star with cosmic pearls) www.hubblesite.org
(Bertrand Russell, “Problems in Philosophy: The Value of Philosophy” in Laurence BonJour and Ann Baker, Philosophical Problems: An Annotated Anthology (New York: Pearson Longman, 2005), 37.)

Time and Conventional Wisdom

2009-04-02T23:32:00.013-05:00

"The conventional view serves to protect us from the painful job of thinking." (John Kenneth Galbraith, economist).

The 21st century is here! Time to get out of our theoretical and philosophical ruts and get on with progress! There's no time for idle thought, for being comfortable with the "conventional wisdom" that perceives revolutionary timekeeping as a function of watch gears. As functional and beautiful as they were in their time, their utility reached its apex long ago. No doubt it served centuries of people, but today's time is marked by microprocessors, not watch gears.

How will nursing move into the microprocessor world? By finding more durable materials for their watch gears? By redesigning the watch casings into something more modern? Through a publicity campaign to maintain the "conventional wisdom" of watch gears?

In all these options the "conventional wisdom" is furtively retained. We are in a new era now. The time of microprocessors, of digital media, of micro-second communication, nanotechnology, quantum dynamics, and gene manipulation has arrived, which makes even Dick Tracy's watch obsolete.

Nursing's philosophical and theoretical progress in the future will come about not by refurbishing its antiquated watch gears, but by gently setting aside any archaic times on the shelf for safekeeping, as reminders of our beginnings, then blazing ahead into the microprocessor world. Wisdom and discretion will guide. Shall we be labeled iconoclasts in so doing? I don't think so, and our heirs won't think so, either.

2009-04-02T12:40:00.017-05:00

(photo of aspartic acid, an amino acid....essential for life)

We take our interpretive cues for communication from multiple factors and it is certainly no different in nursing. The holistic focus within nursing, though, entails an ethic of communication for which I coined the neologism, “vitalogue”© (dialogue of life), which conceptualizes the overarching metaphysic of holistic life. Reality's perspectival dimensions sets communication's stage for “vitalogue”© between nurse and client. This “life-talk” is the fundamental focus of our encounter with our patients as we intervene meaningfully in the nurse-client relationship. We seek to speak and act and communicate in a way that meets our client's needs and desires within the ethical framework of seeking the best for their well-being. It's not the words, per se, that are powerful, but the ethics of goodness, patience, kindness, and gentleness that powers "vitalogue"©.

In the end, it is the ethical relationship that empowers communication. Maybe you find my neologism cheesey. That's okay. Sometimes I think it sounds a little corny, too. But I like the concept behind it.

Desire and Ontology

2009-03-26T13:55:00.015-05:00

In my opinion, nursing philosophy has failed to provide a coherent ontological basis that truly directs nursing research and knowledge development. It's not that everyone is wrong....it's that while many scholars intuitively have identified anthropological factors as critical to understanding man's responses to health/illness, we haven't quite capitalized on the core issue of the most basic element common to all people: desires.

Desire is more basic than intention, choice, or action. Man always does what he most desires at any given moment, within the context of his circumstances. The contextual milieu is critical. If you miss this, you miss my point. I am not saying that man desires being in poverty or oppressed circumstances. Not at all....but every situation involves conscious desire even when only horrible choices exist. Even suicide is expression of the desire for contentment, of satisfaction, that unfortunately is seen as only existing by self-abolishment as a measure to relieve suffering.

The context limits the choices in good and bad ways both. But a person's response to circumstances is always based on their strongest desire at the moment. To seek relief from suffering is another way of saying that people seek satisfaction, pleasure, and contentment and thus always act on their strongest desire at any given moment within the framework of their personal ethics and values.

Desire explains why some people choose healthy lifestyles and why others choose self-abusive habits. It is pleasure we all seek after. How that is satisfied depends on our ethics and values which are shaped by a myriad of factors.

Consider: the most consistent factor among centenarians (those who live 100+yrs.) is not healthy eating, exercise, and abstinence from all vices (however you want to define those). It is optimism, and a belief that "this, too, shall pass".

Consider: Why don't we discipline ourselves in healthy habits?
Could it be we have other desires that are more satisfying to us than good health?

Consider: How can we separate mind, heart, and body?
Answer: We can't. And we need a nursing philosophy that bridges all three. That concept is desire. A second related element is relationship (but we're not ready to discuss that yet).

So what satisfies you? What are your desires? These are very complex philosophical, ethical, and theological questions that must be considered in nursing philosophy. Research should target what influences individual human desires. It is the major determinant of people's choices regardless of race, ethnicity, economic status, sex, religion, or educational level.

Nursing research should be focused at the level of human desire within individual and population contexts. If we can labor to understand what controls desires and help patients identify these, while finding ways to modify desires into those which result in wholeness of person, then we will surely be developing nursing knowledge to truly explain what nurses do in their holistic work to attain well-being within reality's parameters. We will also then forge a road into a new realm of holistic nursing science in understanding how desires influence mind and body.I will be proposing a tri-perspectival model of ethic, existential factors, and situational factors to advance nursing knowledge. A model that will, with time and research, abolish the theory-practice gap. It is a model which I believe will have global significance as the concept of desire as basic to human nature is God-given to all men. As a fundamental ontology it is applicable to all cultures. More on that later.

Postmodernism and the Nursing Philosophy Quandary

2009-02-21T07:50:00.011-06:00

Postmodernism seems to be a catch-all term these days that among the public refers to moral relativism, pluralism, "tolerance", and obliteration of objective truth. Taken to its extremes these things can be true (modernity wasn't any less oppressive, though for different reasons), but postmodernism has much to offer nursing philosophy.

Postmodernism's esteem of holism dovetails seamlessly into nursing's prime value of holistic care. The time is ripe for capitalizing on this as we seek further understanding of how intangible factors impact health. My opinion is that there is a gold mine of information for holism to be found at an anthropological level in the concept of desire. More on that later.

On the flip side, I don't expect much advancement in nursing philosophy this decade. That may seem contradictory to the above paragraph. But nursing's (and medicine's) currrent emphasis is on "evidence-based practice" (EBP), which has the potential to be a throw-back to modernity's slogan, "if it's not measurable, it can't be true". This has huge ramifications for nationalized health care as the federal government has indicated it intends to mandate "outcomes".

Nursing research targeted to EBP leaves little room for development and progression of nursing philosophy. It's an economic problem whereby research funds are preferentially given to EBP models. It's an educational problem as nurses are not philosophers, though graduate and post-graduate programs offer perhaps 2-3 classes in nursing theory/philosophy.

The influence of postmodernism has so far resulted in many narrative reports of patients' experiences, the conclusions of which are philosophically fragmented for several reasons. One reason is that nurses typically pick one aspect of either a secular or nurse philosopher to guide their study without a philosophical application in the end. I may be too critical here because nurses are not philosophers. (Neither am I , but I'm learning...) I assert that if the end result is isolated stories, of what benefit is that to nursing as a whole if there is no working, coherent philosophy as its foundation? What's the bigger picture we're after? I'm not sure as a profession we have an answer to that.

Prognosis: The theory-practice gap will widen to a chasm that will take decades to bridge.

What can we do? I believe nursing should commit funding to philosophical development to further the profession's historical ideals of holistic care. Without a sound philosophical foundation there can be no substantial development of a global nursing initiative. Perhaps nursing needs to partner with professional philosophers to clarify the issues.

Postmodernism has opened a door for me to write nursing philosophy from a trinitarian viewpoint, thanks to the recognition of the value of diverse viewpoints and the recognition that truth is not always quantifiable (in fact, most truth is not quantifiable, even in physics).

Reconsideration of Nursing as "Caring"

2009-01-10T10:29:00.024-06:00

To put it bluntly, I take issue with the fundamental concept of nursing as "caring" for several reasons:

(1) Ethically, nurses are no more obligated to care than anyone else. We are to love others as ourselves, which extends to all spheres of human existence: physical, emotional, mental, and spiritual. This holistic "caring" is not imposed upon nurses any greater than others, so the nursing profession is unable to legitimately lay claim to "caring" as unique to nursing. I do believe, though, that the ethic of love and caring underlies our profession, as it ideally should for all people. But it does not define it.

(2) Adoption of a universal ethic ("caring") as a specific conceptual description of a profession does not clarify the profession of nursing, it only obscures it.

(3) Ironically, the nursing profession suffers at its own hand through its confusion of ethic and professional action. "Caring" is not the profession - rather, caring is the foundational ethic.

(4) Case in point: "Caring" in no way implies the mangled extremity (and mangled psyche) will be skillfully treated. Am I being oversimplistic? Maybe. Irrelevant? No.

So what now? I think conceptual revision is in order. Nursing philosophy needs to be reworked as a matter of first priority for it is what guides the definition of nursing. A clarification beyond "caring" is desperately needed, one that iterates the specifics of our profession while concurrently delineating it from all other professions.

Postmodern western culture, search for global relevancy, and conceptual overhaul...is it necessary? Is it possible? Definitely a daunting task...but I'm pursuing it because.....I care.

(Photo from Iraq war injury photo essay published in the New England Journal of Medicine, December 2004).

Presuppositions Matter!!

2008-07-04T14:42:00.029-05:00

What is this image?

Your answer is dependent upon your knowledge base, your life experience, and on what you believe to be true.

The formation of any answer will first pass through these filters before you assert your most plausible explanation. Your presuppositions are these filters, these primal assumptions, through which you interpret life and assign meaning to it.

Presuppositions are deeply rooted in us, they vary from person to person, and undergo change as we travel through life. They underpin our values and ethics, and constitute the core foundation of all that we are and do; they are the fountain of what we believe ought to be and what ought not to be. They are so fundamental we often don't recognize them, but they direct our thinking and doing every moment.

What did you decide? Abstract art? Computer bit-map? Microscopic cellular disease cluster? Electron microscope photo? Satellite photo? Enlarged pixels?

This image is a satellite photo of irrigation circles in southwest Kansas. Each white dot is a harvested circle, and each red dot an unharvested circle. Each circle is generally 1/2 mile diameter (4 per square mile = 1 section = 640 acres), though they can be up to a mile diameter.

How you answered was contingent on your presuppositions. Indeed, all of philosophy is grounded in presuppositions. For nursing philosophy to be useful, our presuppositions about human nature and the world must be accurate.

There exists a curious absence of presuppositional frameworks in nursing philosophy that I want to identify and wrestle with over the next several years. I am of the opinion that our best chance of a global definition of nursing lies in the secret room of presuppositions.

Thoughts on Ethics and Being

2008-07-01T21:44:00.026-05:00

(This is a slight modification of my comments posted on my son's blog regarding giving to the poor as a part of ministry.)

The bigger picture, as I see it, is that we make a false dichotomy between the physical and the spiritual, which leads us to "formulas" and "plans" for evangelism, and then if we don't "share the gospel" we somehow failed. This is a product of modern evangelical churches that is rooted in the last one hundred year history or so of the Protestant church. A more helpful conceptualization is one of holistic ethic in which all of being is ethic, and all of ethic is being; all of doing is ethic, and all of ethic is doing; all of being is doing, and all of doing is being. Ethic = Being = Doing*.

We cannot separate our daily life from ethics or from ministry (doing). It is a way of being, that while manifested by doing, does not consist materially of doing. We almost would have been better off without the word "ministry" as it implies something we add to our daily to-do list.

When churches emphasize and teach how to be the right person and grow into deeper union with Christ, then "ministry" is spontaneous. The flip side of the coin is that meeting physical needs IS gospel, IS ministry, IS love, and needs no specific "preaching" until such time as God leads. There is a profoundly deep experience of healing in a soul as a need is met by us, that IS Christ in us and IS Christ through us. It is not a dichotomous process of being and doing.

Rare are you if verbal messages from others constitute the pinnacle touchpoints in your life. I venture to speculate it is more likely that your touchpoints were experiences of proclamation of deep gratitude in the abyss of your soul as you marvelled at the grace shown to you by another as your physical or spiritual need was met. In other words, meeting needs in any context IS totally spiritual. In this framework, then, ministry can never be something "added in" to our lives.

Nurses understand this better than anyone. The physical is inseparable from the spiritual. So as I get older I find such a distinction in these discussions is sometimes not that helpful and perhaps we should view ourselves through a different pair of glasses so that we see the totality of our redemptive existence in proper perspective.

*(I had envisioned this model in rudimentary form in 2006 as a framework for nusing philosophy/ontology. Much to my delight, John M. Frame had created and exposited this same perspectival model. His book, The Doctrine of the Knowledge of God (1987, P&R Publishing), is a philosophical and theological argument for the inseparability of ethic (normative), being (existential), and doing (situational). I am indebted to Dr. Frame for allowing me to adapt this model for nursing philosophy. E-mail correspondence 01-23-08.)

Run, Forrest, Run!

2008-05-29T21:25:00.018-05:00

Start talking about nursing philosophy and people want to run. Especially nurses. It's a necessary evil in nursing school that every student does battle with. Typical responses from professional nurses: "it's irrelevant to nursing care", "doesn't reflect reality", "nobody understands it anyway", "it's just an academic thing". Been there, done that.

Here now, doing this. Doing what, exactly?

In the world of nursing philosophy there are theories from every viewpoint imaginable to describe how that theorist defines nursing and conceptualizes the pragmatic. Individual viewpoints are just that. What intrigues me is the great disparity of the theorists' starting points and their fundamental beliefs (which are usually unspoken but unwittingly disclosed in their work). If you read between the lines or critically analyze their sources, you can often find incongruities between reality, assertions, and presuppositions. Very often they are not aware of their presuppositions.

The nursing profession is exploring the possibility of a global, transcultural nursing philosophy. This is an enormous philosophical undertaking given the whole spectrum of sociological, ontological, and epistemological issues. It is akin to physics' search for the "theory of everything". But what some theorists are attempting is a conglomeration of several conflicting philosophies into one amalgamated nursing model that while it includes all, tells us very little about how to practice nursing. Actually I think it tells us nothing.... No, on second thought, it tells us we are confused.
I have some ideas about nursing philosophy at the presuppositional level using a perspectival approach that I hope to develop over the next few years; ones I hope will be engaging, relevant, and uniquely lively. So stay tuned.