Nursing as techne and phronesis

If nursing theory is to be hermeneutic, then it has to be an interplay between techne and phronesis, because nursing can be philosophically understood as needing both to be identifiable as what it is.

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On van Manen: a philosophical-hermeneutic critique

Max van Manen, a phenomenologist in education theory, breaks down the structure of the phenomenological method into six parts. The sixth, “balancing the research context by considering parts and whole” (30-34), is an explicit reference to the hermeneutic circle made famous by Heidegger in Being and time.

What is offered as the third way between theory and practice in teaching by van Manen – namely thoughtfulness (van Manen 1995, p. ?) – can be ontologically grounded through a hermeneutic appropriation of mindfulness (Besinnung), a very important approach to the fundamental question of being (Seinsfrage) in Heidegger’s later thinking. “Lived experience”, as the central operant in van Manen’s phenomenology, risks forgoing the ontic-ontological differentiation that Heidegger explicates in Being and time is crucial to the retrieval of being (Sein) in phenomenological thought. Grounding the naturalism of experience in hermeneutic-phenomenological formulation, say of pedagogy in van Manen’s case, limits the way of thinking to ethnography, which belongs to the ontic discipline of anthropology.

While van Manen responds with affinity to the pedagogic phenomenon of “Schön shock” in the mid-1990s (see van Manen, 1995, p. ?; and Eraut, 1995, p. ?), which revealed the crisis of the impotence of reflection in the classroom experience of a novice teacher, on the ontological level, the Dasein of teaching, which calls for oneness of theory and practice, is uniquely characterised by what Theodor Ballauf, a 20th century German thinker in education theory (contemporaneous with Heidegger), describes as an educator’s innate ability for self-criticism (Selbstkritik), which in fact forms the a priori structure of reflection (Raha, 2008, p. ?). The potentiality for reflective self-criticism makes possible the attainment of the Aristotelian-Gadamerian virtue of phronesis in Dasein – in any professional discipline where the status of novice is inherent in its understanding of development as in gaining of insight and experience, such as teaching and nursing.

Looking back at the beginnings of the workings of hermeneutic phenomenology in Heidegger before Being and time, it is evident that his phenomenological method then was a sustained response to a challenge similar to the “Schön shock”, namely Natorp’s critique of phenomenology as a self-contradiction in that reflection inevitably changes that which is reflected upon, which in Husserl’s phenomenology is the subjectivity of experience (Zahavi, 2003).

 

The lack of the dialectics of aletheia in van Manen’s appropriation of Heidegger is the fundamental weakness in his search for a “method” in what he terms “hermeneutic phenomenology” – a term which is absent in Heidegger’s writings, but which is used by Benner and Plager in Interpretive phenomenology (1994) to introduce Heidegger into nursing theory and to secure his hermeneutic circle as research methodology that has its own rigorous standard and requirements. However, while understandable as a rhetorical device to highlight the humanisation of nursing theory through resistance against and overcoming of the history of the holding sway of natural sciences in this academic discipline in the English-speaking world, in terms of methodology, the expression “hermeneutic phenomenology” is a tautology that does not add meaning to Heidegger’s Werke. This is because in Heidegger, hermeneutics already implies an understanding of phenomenology as a universal ontology to which the historicity of existence, or the ontological historicity in the meaning of Dasein, is integral. In his discussion on phenomenology in Being and time, Heidegger warns as follows:

The idea of an “originary” [ursprünglich] and “intuitive” grasp and explication of phenomena must be opposed to the naïveté of an accidental, “immediate”, and unreflective “beholding” (Heidegger, 1996, p. 32).

While intuition is an inherent ability of the human mind, originary or primordial thinking is based on an understanding of being (Seinsverständnis) as being (Sein) and not merely as beings (Seiende): it calls for an awareness of the ontological difference between the two, or the ontic-ontological distinction in methodological thinking. As Heidegger puts it: “As the fundamental theme of philosophy being [Sein] is not a genus of beings [Seiende]; yet it pertains to every being” (Heidegger, 1996, p. 33). Phenomenology is ontology of ontological difference. This means that a reflective or philosophical discipline to resist the ensnarement of the obvious, or the present-at-hand (Vorhandensein), is required; in his later writings Heidegger describe this as mindfulness of being (Besinnung), such that Dasein is understood as a mindful (besinnend) kind of being. Through being mindful of being, Dasein is a being that, in having its being as a primordial question, stands in a clearing of being (Lichtung des Seins) in the manifold world of physis. Dasein, despite its embodiment, is never purely physical but essentially philosophical, which means that it can never be on either side of the nature-culture divide. (Grounded theory, in its complete reliance on the socialisation of human beings, obscures their potentiality-for-being – Seinkönnen – as Dasein. Dasein cannot simply be understood through observation of its core process as appropriation by society, as if its essence can only be objectified this way through what grounded theorists call the “core variable”).

This is why Heidegger can state that there is an ontological priority to hermeneutics.

Heidegger and the ontological meaning of work

For a student nurse to succeed becoming a nurse, a self-understanding of work is an area of educational reflection in nursing pedagogy. Nursing is commonly understood to be “hard work”: long hours of mentally, physically and emotionally demanding toiling that can only be sustained with proper understanding and sincere dedication. The everyday understanding of work as a necessity in life – to earn a living, to be a useful member of society, to develop self-esteem in the complex web and networks of Mitdasein – is, as Todd S Mei points out in Heidegger, work, and being (2009), hermeneutically inadequate (Mei, 2009, 3). Mei proposes using Heidegger to bring about an “ontological transformation” of work that allows Dasein to participate in the question of being, which is fundamental to the very notion of ontology and may overcome the modern obsession with “utility” and “necessity” in work (Mei, 2009, 2-3). In the case of a nurse, she finds authenticity in her self-understanding as Dasein in what she does and learns as a nurse, which is always enmeshed in the well-being of patients under her care, which is a unique Mitdasein determined by healing or palliative care, either of which in turn determines the meaning of being in nursing. Nursing with self-understanding is essentially Dasein becoming aware of itself as Mitdasein seeking what is whole and hale. It fits in with what is described in Rauschenbach (2000, 115 ff) and is cited in Fleckinger (2013, 16), a MA thesis on Ehrenamt in palliative care, as “ein tätiges, gemeinwohlorientiertes Engagement”. Also relevant and highly poignant is a quotation from Cicely Saunders, the founder of the modern hospice movement, cited in Fleckinger (2013, 44): “We are concerned with persons and we are concerned as persons” (Saunders, 1972, 275). Such interconnectedness of care forms the hermeneutic circle in nursing.

Phenomenon as ontological difference

Being (Sein) qua being (Seiende) determines Dasein‘s encounter and understanding of beings in the world (with Dasein itself as a being-in-the-world in its fundamental mode of being, inalienably and absolutely) and defines its circumspect (umsichtig) way of going about things in its everyday existence as its pre-philosophical, if not vague, interpretation of what is right (was zu Recht kommt) about reality. This unreflective, if not innate or “natural”, hermeneutic relation between being and beings qua Dasein‘s making of it covers over an essential ontological difference between the two and places Dasein in a position of incompleteness in its understanding, hence limiting the interpretative power of its circumspection (Umsicht). God, as an observer of Dasein, may well ask, “Whereto goes this Dasein?”

Phenomenology rejects the metaphysical dichotomy of essence and appearance: phenomenon, by its very definition, is what it appears to be. The same phenomenon may have this or that appearance to Dasein at different times – the temporality of perception, hence of circumspection, is none other than the time of the existential projection of Dasein as a future-oriented (zukünftig) being in its being-toward-death (Sein zum Tode).