Open Journal of Nursing, 2013, 3, 499-502 OJN Published Online November 2013 (
Philosophizing in skilled nursing care: Must or nice?
Fatemeh Khoshnavay Fomani1, Mohammad Ali Cheraghi1, Yahya Ghaedi2,
Rahmatollah Kharazmi Rahimabadi3
1School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2Department of Educational philosophy, Kharazmi University, Tehran, Iran
3Department of Education, Farhangian University, Imam Ali (PBUH) Branch, Rasht, Iran
Received 31 July 213; revised 5 September 2013; accepted 26 September 2013
Copyright © 2013 Fatemeh Khoshnavay Fomani et al. This is an open access article distributed under the Creative Commons Attri-
bution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
To become a professional nurse requires that nurses
learn to think in a right way. Thinker nurses strive to
be clear, accurate, logical, complete, precise and faire
in their practice and manner. In other words, a
thinker nurse is a philosopher who has the ability of
reasoning, critical and reflective thinking. In many
investigations, the role of critical or reflective think-
ing is explored, but in this review article, we are try-
ing to introduce a comprehensive concept that in-
volves all these elements of thinking skills. It is philo-
Keywords: Philosophizing; Nursing Care; Thinking
“Nursing encompasses autonomous and collaborative
care of individuals of all ages, families, groups and
communities, sick or well and in all settings. Nursing
includes the promotion of health, prevention of illness,
and the care of ill, disabled and dying people. Advocacy,
promotion of a safe environment, research, participation
in shaping health policy and in patient and health sys-
tems management, and education are also key nursing
role” [1]. If ever, there were a key component in nursing
practice and education, it would be thinking [2,3]. For
example, in clinical practice, the nurse engages in think-
ing and doing simultaneously [3]. Thinking is embedded
in nursing care and quality of care is regarded as quality
of thinking. Han (2007) stated that even in high techno-
logical care systems, we cannot disregard the role of
thinking. Although in modern health care systems, much
technological development has taken place in caring
context, but quality of care is not depend on techno-
logical developments solely. Albeit technology provides
improvements in health care, but undoubtedly, effective
use of thinking strategies is essential to provide a quail-
fied care [3].
Substantiation of care goals is based on knowledge and
skills combined. In their qualitative study, Buller and
Butterworth (2001) investigated the elements of skilled
nursing and found that skilled nursing practice involves
four domains: doing the job, being professional, relating
& communicating and managing & facilitating [4]. Con-
sidering these four domains, it is evident that a skilled
nurse is a thinker nurse because, the cornerstone of pro-
viding care, being a professional nurse, making relation-
ship with patients and families or other members of pro-
fession and being a skilled manager, is thinking skills
such as reflection or critical thinking. Shiau and Chen
(2008) dissected reflection in medical care and enounced,
while health professionals, are expressing care, they need
to understand that “the process requires looking inward
at one’s own selves, then outward at the world around
them, and then back in again” [5]. It means reflection.
According John (1997) we use reflection on practice, in
order to interpretation of process or experience. In Kem-
ber et al., (2000) definition, process of reflective practice,
is a thoughtful practice into a potential learning situation.
Hall (1995) introduced three types of reflection: reflec-
tion before action, reflection in action and reflection on
action. Reflection as a mental process, applied to gain a
better understanding of ideas that are relatively compli-
cated [6]. By reflection, the nurse, can verify experiences
or situations and analyze them. Also it is an opportunity
to challenge values, beliefs and assumptions [5].
F. K. FOMANI et al. / Open Journal of Nursing 3 (2013) 7-10
It is expected that a skilled nurse be adorned to reflective
maturity because this competency is preliminary of hu-
manistic care. Humanistic care is something more than
medical care. It is a mainstream to get holistic care [5].
In our perspective, one way to get the competency of
reflective maturity is critical thinking. According to Paull
and Scriven (1987), critical thinking is process of ana-
lyzing, synthesizing and/or evaluating information. This
is a worthy and fundamental concept in nursing curricula,
practice and clinical decision-making because of its di-
rect affects in patient outcomes. In context of nursing
care, critical thinking is used to analyze patients
consider patients’ circumstances, needs and feeling, as-
say nursing measures and recognize the appropriate time
to seek alternative treatments. According to Staib (2003),
critical thinker nurses, apply standards and seek informa-
tion in their practice. They have logical reasoning skill
and able to predict events or outcomes also they are ca-
pable to knowledge transformation [7,8]. Lewenson &
Truglio-Londriga (2008) acknowledged that health care
arena is high complex and dynamic while many factors
such as history, legal and ethical issues, spirituality, cul-
ture, media, economic status and health care policies,
impress this circumstance [5]. It is clear that, in this bat-
tlefield, only a thinker nurse can overcomes the barriers
and provides an eligible care.
In nursing discipline, the most preferred caring, is holis-
tic care. This claim can be support by McEvoy & Duffy
(2008) explanation: “nursing is indeed holistic in nature”
[9]. In the philosophy of holistic health care, people are
something more than body and mind. Human is com-
posed of mind, body and soul integrated into a whole
with inseparable parts [9,10]. The whole is in dynamic
interaction within itself and universe and well-being is
the sequel of balance and harmony in all parts. Maybe
Nightingale was the first nursing theorist that mentioned
holistic care. When she (1996) stated one of the nurse’s
roles is putting the patient “in best condition for nature to
act upon him”, and for 100 years, the nursing, conform
her guidance, the holistic health care in nursing practice,
implicitly acknowledged. It is accepted that the nurse
role is to help people get well, stay well and even have a
peaceful death. It is Oppressive that, some nurses often
failed to recognize the worthiness of their care [10].
Having a holistic point of view and doing this way, is
embedded with thinking. Thinking process helps the
nurse to understand the whole of clients or patients.
Thinking is a magic wand for making harmonies or di-
agnosing disharmonies and fixing that.
Not only it is expected that nurses will be good thinker,
but the community’s expectations from nurses, is receiv-
ing services in the field of mind and thinking too. This
expectancy is rooted in the nurses’ roles in health promo-
tion. For instance, mental health, as aspect of human
health, is one of nurse’s roles that is related to mind and
thinking process. In the international classification of
health workers (2010), nurses as “health workers”, pro-
vide treatment, support and care services for people who
are in need of nursing care due to the effects of ageing,
injury, illness or other physical or mental impairment, or
potential risks to health, according to the practice and
standards of modern nursing” [11]. In this classification,
providing care and treatment to individuals with mental
problems is mentioned. Moreover health promotion and
the desire to promote healthy communities is a focus in
nursing discipline. These ideal goals are supported in
nursing programs and curriculum as well as community
activism by individuals and groups of nurses [12]. In
other words, one of nursing mission is promoting well-
ness in individual and community levels. Moore & Hu-
erena (2005) and World Health Organization (2006)
mentioned that the core of health concept is wellness.
Carlson (2003) believes, wellness is based on promotion
and maintenance of health and capacities for living rather
than on healing of poor health and solving problems [13].
According to the Mickinley Health Centre, University of
Illinois, wellness is “a state of optimal well-being that is
oriented toward maximizing an individual’s potential.
This is a life-long process of moving towards enhancing
physical, intellectual, emotional, social, spiritual and
environmental well-being” [14]. When we talk about
wellness promotion in nursing practice, we are confirm-
ing that a skilled nurse as a thinker health worker, is re-
sponsible to promoting all aspects of wellness in all lev-
els of individuals, families and communities. Wellness,
as mentioned above, is a process with a progressive es-
sence to catch well being. How we can promote our
wellness, without good thinking strategies? If we are
nurse or patient, we must rely on our thinking skills to
make our life better and get to our maximize potentials.
For many years, we are training and educating our nurs-
ing students, to learn the way of right thinking. Not only
in nursing education, but in any discipline, learning to be
a good thinker, is focused and counts a worthy aim [15].
Copyright © 2013 SciRes. OPEN ACCESS
F. K. FOMANI et al. / Open Journal of Nursing 3 (2013) 7-10 501
In modern academic educational systems, the ultimate
goal is to produce individuals more than technicians who
do any routine tasks in their profession or job. Graduates
must possess creativity, imagination, sensitivity, and
communication skills as well as proficiency and ability
to analyze and synthesize situations. In medical educa-
tion, goal oriented approaches, based on multidiscipli-
nary integration, has the potential to prepare the individ-
ual to response to rapid changes in society and therefore,
the professional members, will be more proficient in
their roles and tasks [16]. Although many theorists try to
find a feasible way to catch this educational systems de-
sire, but historically, philosophy has been the ensign, in
this battlefield. Between many models and methods try-
ing to teach students, the right way of thinking, Matthew
Lipman model (2003) was an innovative, walkaway and
philosophical model that stand out. “Philosophy Goes to
School” and the followed book titled “Philosophy in
Classroom” as well as stories and exercise books for
children and adolescents, was parts of Lipman effort in
this way. He tried to explain how we can integrate phi-
losophy examination to education [15]. In fact, Lipman
as one of the most influential person in education intro-
duced a new paradigm in this area and paved roads to
reach their destination that has always been the desire of
all actors in the field of education. His model adjusts to
fast changing societies that are moving towards global-
ization and to the citizens who increasingly struggle to
make sense of the world and of their lives [17]. This part
of Lipman model, is exactly applicable to today’s nurs-
ing world because of the changing nature of health care
and globalization in nursing profession. Lipman believed
that skilled individuals thinker, are those have three skills
thinking: critical, creative and caring thinking [15]. Thus
Lipman model can be an integrated framework that con-
tains all core elements of thinking skills has been intro-
duced in other models. There are some frameworks de-
signed by theorists that introduced thinking skills, but the
most widely accepted is Bloom’s Taxonomy (1956) [18].
In lipman’s model, creative and critical thinking is dealt
with cognitive domain of Bloom’s Taxonomy and caring
thinking is mostly related to affective domain of this
taxonomy. Caring thinking is just like a formula bringing
critical and creative thinking together. Through caring
thinking, we convert our felling to our choices, decisions
and even judgments. Caring thinking is the philosophical
verification and justification of critical and creative
thinking [15]. Philosophizing is “to reason in the manner
of a philosopher” [19]. Therefore according to lipman
philosophical model, when we talk about philosophizing,
in fact we are referring to critical, creative and caring
thinking skills together. And a philosophizer, thus, who
has the ability of analyzing, synthetizing, logical reason-
ing, predicting, thinking about our and other’s ideas or
emotions, verifying situations and challenging values and
Philosophizing is a comprehensive concept that involves
all elements of thinking skills. Nursing as a practical
discipline, needs “practical nurses” and practical nurses
are able to “practical think”. It might seem that a practi-
cal thinker constantly eliminates thinking or reflection
from the material world equation, but the material world
and the world of thinking are and shall remain in an in-
separable symbolic [20]. Especially in nursing care con-
text, the nurse deals with a human as a patient or client.
Going toward professionalism in nursing and providing
holistic care for patients, or promoting health care and
wellness in individual and society levels, it needs to ap-
ply good thinking strategies. Philosophizing is a cogni-
tive competency that integrated all thinking skills and
deserved to be included in education and nursing prac-
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