The Multifaceted Structure of Nursing:

Writing at the interface between classical philosophy and contemporary nursing poses some interesting problems. Strictly speaking, scholars of Aristotelian philosophy have no basis for consideration of nursing except what Aristotle wrote about health and medicine. Contemporary medicine has little in common with ancient medicine except the end of health and the continuing respect of some physicians for the Hippocratic Oath. Twenty centuries ago when Aristotle recorded his insights, physicians practiced on the level of a craft, performing simple skilled procedures with the hope that an improved state of health would occur. E.D. Pellegrino and D.C. Thomasma (1980, Pellegrino,1998), argue that medicine is an ethical art in its professional practice. Professionals use techniques in an instrumental way but performing the techniques does not constitute the discipline of medicine. Excellent practice and virtue are required by the physician-patient relationship. Within this line of reasoning nursing is not a craft, although there are very technical aspects of nursing and some practitioners function on the level of craft. This broader image of nursing is reflected in its being characterized as an applied art (Johnson, 1996), an ethical practice (Blondeau, 2002), and a practical science (Whelton, 2000).
As practitioner and philosopher, one is faced with options. One option is a strict reading of Aristotle within which nursing does not fit or becomes a branch of ancient medicine and thus a technical art. This option makes Aristotle irrelevant because it does not capture the reality of contemporary nursing. Such an approach does not seem reasonable. Coming to philosophy
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twenty years ago with twenty years of prior clinical nursing, I could place nursing practice within what Aristotle wrote. As an example, let me share something that makes me smile whenever I read it. Student nurses are drilled on the “five rights” of medication administration. I remember them as the (1) right medication to the (2) right person at the (3) right time in the (4) right amount in the (5) right way, the right mode of administration. Within his ethical writings, Nicomachean Ethics, Aristotle teaches that we are virtuous when we experience pleasure and pain “at the right time, toward the right objects, toward the right people, for the right reason, and in the right manner (1106b20-22).” Again, in nursing we are taught to practice within principles and make choices based on principles we have learned, and not just feelings or intuitions of a person’s need. These feelings are important and tell us things that sometimes cannot be put into words but for the most part we are to (1) know what we are doing, and to (2) choose to act for the benefit of the patient or family to move them toward the good end of health or a peaceful death, and we must (3) act consistently for the benefit of the patient and/or their family. These are also the characteristics of a virtuous act (1105a30-33). These readings suggest that at the level of practice, nursing is an ethical practice. Nursing is about scientific knowledge and skill, and about human interactions, but it is also about making decisions and acting for the good of others.
A practical or applied philosopher prefers to learn as much as possible from the ancient texts, in this case Aristotle’s Nicomachean Ethics, and then bring forward methods and ideas that will be helpful within contemporary practice. Within the scientific works it is easy to see that one cannot accept Aristotle’s cosmology with all that contemporary science has discovered. Does this mean that we ought to read Aristotle as a piece of literature, interesting but really “shelf material?” There is another option. One can read Aristotle in a way that acknowledges the historical context of the writing but looks for what is perennial bringing that forward to provide
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methodological and content insights for contemporary philosophy of science (Wallace, 1983, 1996).
What follows is an exposition and application to nursing of Aristotle’s treatment of the discipline of politics 2 with its four-fold structure; speculative, practical, ethical, and legislative. The present discussion will use Aristotle’s treatment of politics, the single but multifaceted discipline, to show that nursing can also be considered a single multifaceted discipline. Nursing also includes science (speculative and practical), practice (art and ethics), and legislation.3 The speculative aspect of nursing has a parallel within politics as political science, the study of noble and true behaviors (Aristotle, 1094b15). The master politician, both as student of humans within the body politic and as community organizer parallels nurses who do research into practice and those who use research within patient care and community health.
Similar to proper individual actions within a community, proper nursing acts entail not only knowledge but also ethics. They are principle-based actions for the good of the other as distinctly different from ones self. These actions require insight into principles that apply in the particular situation (wisdom) and the courage to act on what is known. The legislative and administrative practitioners of nursing construct healthy communities and well-run health-care organizations. Thus, as with politics, in the ideal, nursing requires science, art, ethics and good policies forming a community within which excellent nursing practice can flourish.
Thus, the current paper compares Aristotle’s treatment of politics in the Nicomachean Ethics and the way the identified divisions of politics parallel the multifaceted nature of contemporary American nursing. We begin with Aristotle’s sketch of politics that frames it as political science, practice, and legislation. Politics, as described by Aristotle, acts both locally and centrally, either at the state or national level. Functioning for the good of society, politics is an ethical science and art completed by prudential judgements, also called the virtue of practical
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wisdom. This requirement for virtue may explain why the discipline of politics is framed within Aristotle’s classical work on ethics.