Ruth asked:

I need to know if this a philosophical question....I'm a nurse taking a philosophy course in which I
have to give a presentation regarding a philosophical issue that arises in a nursing context. I will then
use a philosopher to give some direction to its resolution. Please advise.

Q: What is nursing care? or, What is care?

I will use Heidegger and Russell to give direction and resolution. Thank you for your input.

============

What a fascinating subject! And so important at the moment too. If you do manage to find a clear way
of defining what constitutes 'nursing care', then, among many others, I think the Scottish Government
would very much like to hear from you- it has been a major topic of debate there of late, and one with
significant financial implications too.

It has all become rather confusing, hasn't it? The traditional differentiation between the medical doctor
as diagnostician and the nurse as the deliverer of treatment is no longer at all clear. For instance —
and this is a very real example — if I were to break my leg today and be taken to the accident and
emergency department of my local hospital, then diagnosis would be made, not by a physician or a
surgeon, but by a nurse. Treatment would then very likely be given, not by a nurse, but by a specialist
HCA who, though highly skilled and experienced in orthopedics, has no nursing qualifications and is
not permitted the title of 'nurse'. Yet he is allocated a nursing grade and paid a staff nurses' salary. All
very odd. Even odder that, I could, in England, be sufficiently qualified in nursing care to be legally
permitted to be in charge of a care home, clinically supervising and directing nurses, but, if I had
trained through an entirely practical route, the Royal College would decline recognise me as a nurse.

I presume that in Heidegger you are looking to his 'phenomenological reduction' and in Russell some
part of the theory of descriptions, but may I suggest either an alternative or an addition? I'm sorry if
that just adds extra confusion, but, then, what are philosophers for?

I do think that we so often in the west forget the contributions of the east, and there we can find
something very valuable, which might just suit your purpose. Confucius, like our own Socrates, was
very much concerned with defining a philosophy for the administration of the State. When Tsze-lu
asked the master how he would begin to organise an administration, Confucius replied that the very
first thing was be certain about how names were to be applied to official positions. Isn't this odd?
Confucius didn't begin with training or with organising a hierarchy or defining goals, but with names.
And he was very, very serious about it...

"If we cannot apply clear names, we live public lies. If we live public lies, the system of administration
is a sham. When the administration is a sham, civil order and refinement deteriorate. When civil order
and refinement deteriorate, injustice multiplies. When injustice multiples, the whole of society is at
risk."

This is what is called the "Doctrine of the Rectification of Names" (cheng ming), and is considered
one of the central planks of Confucian ideas. I throw it in because, it strikes me, this is precisely the
situation with nursing. It is clear that, whatever 'nursing care' is, it is something that nurses do, but it is
far from clear at the present time (as my couple of examples show) what constitutes a 'nurse'. Without
clear usage of names perhaps the system of administration does indeed become a sham. Whether
the health care system has yet reached the point where injustice is ready to multiply, you will probably
be better placed to judge than I. But I do think it could well do with having some of its names rectified.

Is it a philosophical question? Yes, of course it is. Every question is a philosophical question, for
philosophy is not a set of answers but a way of approaching questions.

(You might care to glance at the article 'Delegation Dilemmas' in Nursing StandardDecember 1999)

Glyn Hughes