Academic journal article Scholarly Inquiry for Nursing Practice

Practical Nursing Judgment: A Moderate Realist Conception

Academic journal article Scholarly Inquiry for Nursing Practice

Practical Nursing Judgment: A Moderate Realist Conception

Article excerpt

Under the influence of idealist mainstream thinking that reality is minddependent, many nurses are dismissing the possibility of attaining objectively true judgments. A worrisome trend that has emerged from such thinking is to recommend that nursing practice decisions ultimately be based solely on subjective judgments. We present a conception of practical nursing judgment based on the common-sense philosophy of moderate realism, which has the potential to help offset the trend. It allows for nursing decision making in which nursing principles and rules are modified in light of the contingent circumstances of a nursing situation, resulting in decisions which have both a subjective and an objective aspect to them. This feature, plus the fact that the nursing principles are grounded in common natural needs, rights, and obligations, provides nurses with a basis for nursing care which is individualized, just, benevolent, and sensible, a means requisite to making our lives good.

Nowadays, under the influence of idealist mainstream thought that reality is mind-dependent, many nurses (e.g., Appleton & King, 1997; Barnum, 1994; Mitchell, 1994; Moccia, 1988; Munhall, 1982; Sandelowski, 1996) are dismissing the possibility of attaining bias-free or objective truths (i.e., judgments which are objectively true by virtue of their correspondence with reality as it exists independent of the mind). Objective truths are said to be unattainable because reality and measures of truth are a matter of whatever worldview one has chosen to adopt based on one's own values. Since values are held to be subjective (a matter of taste or preference and unarguable), as opposed to being objective in nature (a matter of truth and arguable) and, as Adler (1990) states, the worldview itself is a construction of individual imagination about what can be, not what is, any particular perspective based in a worldview (and any judgments emanating from it) is seen to be subjective. Thus, nurses speak of all knowledge as value-laden and being of "multiple realities," multiple conceptions of reality-all equally valid, acceptable, and unarguable. The "truth" of a judgment is determined solely on the basis of the individual's say-so.

Born of such idealist thinking is a worrisome trend recommending that nursing practice decisions (i.e., practical nursing decisions or judgments) ultimately be based solely on judgments emanating from an individual's or a group's perspective of a(n) situation, experience, or entity. In other words, since perspectives (and judgments emanating from them) are thought to be subjective in nature, nurses are being urged to ultimately base their decisions solely on subjective judgments. In this philosophical essay, we present the result of our philosophizing: to develop a conception of practical nursing judgment that has the potential to help offset the trend. We begin by setting down the fundamental philosophical underpinnings of our thinking. We then describe some bases for nursing decision making illustrative of the current trend of relying on subjective judgments. Next, we outline a conception of justice and present salient aspects of a conception of practical judgment upon which our conception of practical nursing judgment rests. Finally, we outline our conception and explain why it has the potential to help offset the trend.

FUNDAMENTAL PHILOSOPHICAL UNDERPINNINGS

Our essay is based on the assumptions and tenets of moderate realism, a common-sense philosophy which attains its principles by reflecting on commonsense knowledge and reasoning therefrom in light of available evidence. Common-sense knowledge consists of those judgments we all form as a result of our common sense: our proclivity to develop opinions based on our common experience (e.g, everyone suffers good and bad fortune), experience gained simply from living day to day (e.g., the experience of physical pain). Judgments can also take other forms: (1) mere opinion, opinion expressing emotional predilection or personal prejudice (e. …

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