The Careful Nursing Philosophy and Professional Practice Model© (Careful Nursing) (Meehan 2012) is a unitary system of thinking and acting for the purpose of protecting sick, injured and vulnerable people from harm and fostering their healing and health. The nursing profession, as its name specifies, is distinctively a nurturing, relational profession concerned with protecting people from harm and fostering their healing and health within the context of nurse-patient relationships.
Careful Nursing also aims to strengthen and support nurses in their practice and in their control over their practice and practice environment. Careful Nursing's three philosophical principles, four practice dimensions and their total of twenty concepts are shown in this Figure:
Relationship between the philosophy and professional practice model
Careful Nursing is structured as a unified philosophy and professional practice model because philosophical thinking about nursing guides nurses' practice: thinking must be explicit and can never be separated from practice.
The on-going philosophy – practice conversation
The Careful Nursing philosophy and professional practice model can be thought of as being continuously engaged in conversation with one another. In this conversation we examine, clarify and critique our ideas and how they guide our practice. This conversation helps make our nursing knowledge and practice as visible as possible to ourselves, our colleagues and the people we care for.
The conversation begins with the professional practice model, which is grounded in actual skilled nursing practice, telling philosophy about its history and the mandate it has from societies to provide its particular service. It asks philosophy for a reasoned, critically analysed, coherent framework of ideas and assumptions that are consistent with the nature of nursing and, thus, will help nurses understand, explain and develop nursing practice in explicit detail.
The practice model asks philosophy specific questions, for example: What is the nature of nursing? What is the nature of the human being? What is the essence of the nurse-patient relationship? What is goodness in nursing? What is health from a Careful Nursing perspective? What distinguishes the nursing profession from other healthcare professions? It also asks philosophy questions about its dimensions, concepts, values and ethics.
The practice model emphasises that it wants answers that are consistent with its professional mandate; its distinctive service to society; its actual day-to-day experience of practice. It emphasises particularly that it wants help with critical thinking; it wants to foster and further develop critical thinking skills so that it can become skilled at debating strengths and limitations of its ideas, assumptions, the nature of its relationships with patients, and clinical skills.
In response to the professional practice model, philosophy lays out its great expanse of knowledge developed over many centuries and invites it to choose ideas and systems of thought that are consistent with its experience of day-to-day nursing practice and which will best explain its professional practice in explicit detail. Philosophy explains that its primary method of knowledge development is reasoned argument and that it excels in critical thinking.
Philosophy enthusiastically engages in this conversation because its reason for existence is to offer its knowledge to all disciplines and fields of study for them to select the ideas and assumptions that are consistent with their aims and mission (Scruton 2005). Philosophy assures the professional practice model that once it chooses the ideas and systems of thought which are consistent with its practice, it will stimulate debate about them and inform and infuse nurses practice explicitly with its chosen ideas and systems of thought. The relationship between the philosophy and professional practice model is shown in this Figure:
Structure of the conversation
Philosophy suggests that its conversation with the professional practice model be structured in the three ways suggested by Bruce et al. (2014):
philosophy as an approach to examining the core content of nursing
philosophy as a method of debating concepts, issues and ethics of clinical practice situations
philosophy as a way of life; a way of professional practice.
In the following Figure Careful Nursing's three philosophical principles, four practice dimensions and their total of twenty concepts are shown in a practice format diagram. This format represents nurses in action. The sick, injured and vulnerable people nurses care for (patients) are not represented in this Figure but are the focus of the practice it represents. Careful Nursing aims to protect sick, injured and vulnerable people from harm and the foster their healing and health, or sometimes peaceful end of life. Careful Nursing also aims to support and strengthen nurses in their practice and control their over their practice:
The philosophy and its principles, and the dimensions and their concepts are described and explained in their separate webpages.
Careful Nursing knowledge development
Careful Nursing is not a conceptual model
The above practice-oriented figure of Careful Nursing illustrates a theoretical framework for nursing knowledge development. However, it is important to emphasise that Careful Nursing does not encompass a conceptual model of nursing, that is, a model constructed from postulated nursing ideas and concepts per se. Rather, Careful Nursing encompasses a professional practice model, that is, a theoretical framework of concepts which is constructed from nursing practice events that actually took place and have been judged to represent skilled nursing practice (Nutting & Dock 1907/2000, Doona 1995). Thus, it offers a practice-related philosophy and theoretical framework for nursing knowledge development.
Careful Nursing aims to strengthen nursing practice
Careful Nursing is not concerned primarily with advancing nursing science. Rather, as a professional practice model Careful Nursing is concerned primarily with strengthening nurses' control over their practice and practice environment, and demonstrating clearly nursing's distinctive contribution to care of sick, injured and vulnerable people, as is the primary concern of all professional practice models (Slatyer 2016). However following from its primary concern,Careful Nursing is well placed to contribute to the development of distinctively nursing knowledge from philosophical, scientific and practice perspectives.
Careful Nursing's contribution to nursing knowledge development
Following Dubin (1978), Moore (2011) defines a theoretical framework as 'a group of statements composed of concepts related in some way to form an overall view of a phenomenon', in our case, Careful Nursing. Moore (2011) observes that theoretical frameworks provide two types of explanations about phenomena (observable facts and events) in the world; one type is descriptive, for example, defining, describing and understanding relationships among Careful Nursing principles, dimensions and concepts (variables), and one type is prescriptive, for example, proposing outcomes of implementation of philosophical principles and practice dimensions and concepts.
It is anticipated that over time Careful Nursing will contribute significantly to development of knowledge about the nature of nursing and to the development of middle-range nursing theories.
Bruce A, Rietze L & Lim, A (2014) Understanding philosophy in a nurse's world: What, where and why? Nursing and Health, 2, 65-71. http://www.hrpub.org/download/20140701/NH2-16802412.pdf
Doona ME (1995) Sister Mary Joseph Croke: another voice from the Crimean war, 1854-1856. Nursing History Review 3, 3-41.
Dubin R (1978) Theory Building. The Free Press, New Your, N.Y.
Meehan TC (2012) The Careful Nursing Philosophy and Professional Practice Model. Journal of Clinical Nursing, 21, 2905-2916.
Moore SM (2011) Theoretical framework. In J.J. Fitzpatrick, Encyclopedia of Nursing Research. (3rd ed.). [Online]. New York: Springer Publishing Company.
Nutting A & Dock L (1907/2000) A History of Nursing From the Earliest Times, to the Present Day With Special Reference to the Work of the Past Thirty Years. Vol.3 Bristol, UK, Thoemmes Press, 86.
Scruton R (2005) Philosophy: principles and problems (3rd ed.). London: Continuum.
Slatyer S, Coventry LL, Twigg D & Davis S (2016) Professional practice models for nursing: a review of the literature and synthesis of key components. Journal of Nursing Management 24, 139–150.
Therese C. Meehan©