The human race has been grappling with a plethora of undesirable health conditions for a long time now. The human immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are prime examples of these undesirable health conditions. Its first official diagnosis was in 1981 in California, in the USA (McCready, 2010). Though initially associated with gay men, the disease proliferated and transcended the initially perceived boundaries to affect heterosexuals, drug addicts, and recipients of blood through transfusions (Armstrong, 2009). Since its first diagnosis, HIV/AIDS has grown to become a global epidemic whose cure still baffles medical researchers to date. However, researchers have developed Antiretroviral Therapy (ART) drugs, which bring about a remission of the effects of the illness thus increasing the life expectancy of HIV/AIDS victims.
Medical care for HIV/AIDS patients was initially a preserve of respiratory physicians and experts in clinically infectious diseases (Björnsdóttir, 2001). This assertion holds as it was categorized among acute illnesses (Code, 2006). This categorization changed over the years after discovering ARTs could deal with opportunistic infections and allow HIV/AIDS victims to live longer. The nature of HIV/AIDS has presented caregivers with numerous challenges ranging from handling the stigma associated with its victims to the risk of infection in the process of caring for them (Drummond, 2004). Nurses, as the core caregivers in health facilities, have thus had to juggle between their personal beliefs and the ethos of their profession in the process of providing care for HIV/AIDS patients (Allen, 2004). This essay explores the foundational philosophical sources and experiences in nursing that are essential for building a knowledge base and skill in nursing care for people living with HIV/AIDS with a focus on the Ghanaian context.
Overview of the development of nursing knowledge
Canguilhem (2008) notes that nursing knowledge is obtained from an array of complex sources which include science, experience, and personally deduced understanding. The assertion seems to point to the idea that the knowledge that a nursing student gains during training are a rudimentary foundation, which only serves to prepare the student for the real learning process that comes through personal experiences and those of others in the nursing profession (Georges, 2008). These experiences coupled with foundational philosophical ideas from the past help in advancing the knowledge and understanding of issues inherent in the nursing profession.
In Africa, nurses form a fundamental part of the health workforce. This assertion holds as the African continent claims a considerable share of the world’s disease burden yet most African countries still experience an acute shortage of health workers. Compared to the Western scenario, it would be logical if the training of an African nurse were more intense (Radcliffe, 2000). More often than not, nurses are faced with circumstances in which they have to assume the role of a physician (Harding, 2004). Unfortunately, despite this state of affairs, most African countries still offer their nursing professionals only basic general training, which implies that the African continent with its load of disease especially HIV/AIDS, faces obvious challenges in caring for its patients. This aspect necessitates a systematic exploration of the development of the existing nursing knowledge and it finds out how applicable it is to the African context.
Foundational philosophical sources of nursing knowledge
The field of philosophy overlaps virtually every other field of study. Like any other area of study, the knowledge that governs nursing has a philosophical aspect to its origin. Fawcett (1978) opines that the body of knowledge that comprises the fundamental concepts that support the nursing practice is referred to as a nursing theory. The nursing theory thus incorporates numerous philosophies that were advanced by nursing theorists to make the foundation of the nursing practice (Foucault, 1982). Florence Nightingale is considered the ‘mother’ of modern nursing because she demonstrated that nursing could supplement medical practice by reducing mortality (Holzemer, 2008). She went ahead and established the first institution that offered formal training for nurses. Therefore, it follows that the existing body of nursing knowledge owes it’s being to Nightingale. Her nursing philosophies heavily influenced many other nursing philosophies that were developed later and as such, they continue to inform modern nursing practice.
Nightingale developed the environmental nursing theory in which the principal idea is that the major role that a nurse should play is to ensure that a patient is in the best possible condition from which nature can act on him/her to bring about healing (Mol, 2006). All her efforts in contributing to the nursing discipline focused on how a nurse, through changing the environment, could bring healing to a patient. The theory was broken down into the major canons including proper ventilation, adequate lighting, cleanliness, adequate warmth, quiet, and a proper diet that needed to be observed in caring for patients (Mill & Ogilvie, 2002). According to Nightingale, these were the most important aspects of the environment, which needed to be changed to provide a patient with the necessary comfort. Her ideas continue to be utilized in today’s nursing practice albeit with slight changes brought about by technological advancement and many other changes, which have transpired since the theory was developed. For instance, the solace of a patient is still fundamental in nursing practice.
Another nursing theorist whose nursing philosophy forms an essential component of today’s body of nursing knowledge is Jean Watson. She developed the Human Caring Nursing Theory in which she avers, “Nursing involves the application of art and human science through interpersonal transactions” (Pols, 2006). This philosophy makes several assumptions, which facilitate its successful application to any nursing situation, viz. caring is only effectively achievable interpersonally, proper care enhances individual and/or family growth, a caregiver should accept a patient in terms of what s/he might become later, and that caring is the core of nursing among others (Cameron, 2006). These assumptions provide a platform on which several identified factors interact to render the most holistic and effective care for a patient. The factors in question include nurses’ activities such as giving the patient hope and faith, earning their trust, helping in gratifying their human needs and providing transpersonal teaching among others (Sochan, 2011). This philosophy embodies the true picture of modern nursing.
Another theory that has provided a foundation for the development of today’s nursing knowledge is the Goal Attainment Theory brought forth by Imogene King. She asserted that any patient has three interacting systems, viz. personal systems, interpersonal systems, and social systems (Santos, 2005). In consideration of these systems, at the individual level, what is important is how the nurse perceives the individual patient vis-à-vis her personal views. At the interpersonal level, the focus is on how the nurse interacts with the patient. The nurse-patient relationship is considered the most important during the caring period and thus a nurse should strive to make the most out of it. At the social level, emphasis is placed on how the nurse interacts with fellow workers, seniors, and the environment during his/her caregiving activities (Shaw, 1993). As the three systems interact around a patient, King adds that they adopt a definite process, which encompasses an action, a reaction, interaction, and finally a transaction. The key aspect of this theory is that it gives direction on how a nurse should behave in the presence of a patient. Therefore, the current knowledge about how nurses should act in the presence of patients heavily borrows from this hypothesis.
The Self Care and Self Care Deficit theory as postulated by Dorothea Orem also contributes to the existing nursing knowledge. This theory asserts that there are three distinct levels at which care is supposed to be given to patients, viz. wholly compensatory care for paralyzed patients, partially compensatory care for patients who can perform some care activities on their own, and supportive education for patients who can self-care but lack the basic knowledge to do it (Risjord, 2010). This model thus focuses on the patient’s ability before ascertaining which category of care is appropriate, but the emphasis is placed on patient education and supportive measures, which is a very important component of nursing today.
These are just a few of the many foundational philosophical sources, which have influenced and continue to influence the evolution of the body of knowledge that exists today. Nursing students are exposed to many of these theories in a bid to help them identify theorists’ personal nursing philosophy that appeals to them most because during practice, and thus it is prudent for every nurse to adopt at least one of the existing philosophies and use as their personal philosophies.
Foundational experiences that inform nursing knowledge
As aforementioned, the currently existing nursing knowledge developed from a variety of sources. Among these sources are the experiences of early nursing experts such as Florence Nightingale. Practices such as bathing patients before the mid-morning, regular recording of temperature, blood pressure, and pulse, and formal team handovers at the end/beginning of a shift are entrenched in today’s nursing practice (Scott, 1991). Interestingly, a careful inquiry into why they are done seems to indicate that they are done simply because things have always been that way. This aspect shows that through experience, someone thought that these activities added value to the nursing practice and thus incorporated them into the existing body of nursing knowledge.
Concerning the mother of modern nursing, Nightingale’s experiences in the nursing career form an important part of today’s body of nursing knowledge. Equipped with her belief that dirt was the cause of diseases, she immensely contributed to the welfare of British soldiers during the Crimean War by thoroughly scrubbing ailing soldiers and their environment so that they could be nursed in a clean and healthy environment (Pyyhtinen & Tamminen, 2011). The results of the campaign were overwhelmingly positive. After the war, she used her experiences to formally train professional nurses in an institution she founded (Gadamer, 1996). The current student nurse is prepared to believe that cleanliness is paramount when caring for a patient, which is a clear indicator that Nightingale’s ideas and experiences continue to inform the nursing practice even in the contemporary world.
In a separate case, Dorothea Dix’s experience with the mentally ill in Massachusetts in the 19th century demonstrated to the medical profession that just by making conditions better for such people, some of their illnesses could be cured (Carper, 1978). This perception was a total departure from the traditional treatment where such people were chained, caged, or placed in pens, and physically beaten with all sorts of objects into obedience (Dickoff & James, 1968). Today, there are special facilities for the mentally ill in which they receive extra care in the hands of specially trained personnel (Judd, 2009). This move has led to the cure of many cases of mental illness across the world, and thus an indication that Dix’s contribution continues to influence current practice in this area (Camargo, Cameron & Smith, 2012).
Another person whose personal experiences continue to influence nursing today is Florence Wald. She devoted her life to compassionate caring for the terminally ill (Cameron, Ceci & Santos, 2011). Through her efforts, she founded Hospice Incorporated in Connecticut, which serves as a model for hospice care within and outside the USA (Daves, 2005). This aspect implies that the knowledge that exists about hospice care including training programs and key principles, which underlie hospice care, owe their origin to her, which makes Wald an instrumental contributor to the nursing ethos through her experiences.
There are many more early leaders in nursing practice whose contributions have greatly shaped the existing body of nursing knowledge. Nevertheless, this essay shall stop at the number already highlighted, and move on to explore how these foundational philosophies and experiences have influenced and continue to influence the care for HIV/AIDS victims.
Relevance of the highlighted philosophies and experiences to caring for HIV/AIDS patients in Ghana
The history of the nurse-patient relationship in Ghana elicits ambivalent reactions from different quarters. Many sources have portrayed health workers, especially nurses in Sub-Saharan African countries including Ghana, as abusive, harsh, and rude towards patients (Rafferty, Allcock & Lathlean, 1996). Coupled with these issues, such nurses are reported to handle patients discriminatively. In a study by Dapaah (2012), one patient was reported to claim that the nurses handle patients based on the type of illness one suffers. In a feature article, which was posted on Ghanaweb on 2 June 2009, the author castigates Ghanaian nurses for use of unofficial language on patients (Dapaah, 2012). The article additionally points out that some nurses were even aggressive and violent towards patients. A study by Caine and Lavoie (2011) established that nurses in a certain Ghanaian hospital discriminated against patients using education level as a yardstick. Those known to have a higher level of education were treated well and given quality care while the illiterate were labeled “villagers” and treated with impatience and arrogance (Donaldson & Crowley, 1997). In the study by Dapaah (2012), it was further established that nurses often rendered prompt and high-quality treatment to patients that they knew at the expense of unknown patients.
The highlighted cases are general, but they picture the nurses badly enough to even discourage one from seeking medical attention from healthcare facilities in Ghana. The cases embody a complete departure from the professional discourses associated with the nursing profession. Looking at this issue in the light of the noble ideals that were postulated by the early champions of the nursing profession, paints the Ghanaian nurses in an opposite picture, which is a complete departure from established nursing conventions. For instance, the Nightingale Pledge, which is akin to the Hippocratic Oath sworn by physicians, is commonly sworn by nursing trainees globally to affirm their commitment to the ethos of the profession (Weinberg, 2006).
However, the study by Dapaah (2012) focused specifically on the nurse-patient relationships, especially for HIV/AIDS patients and the findings were different from what these other studies reported. Dapaah (2012) found out that some nurses demonstrated respect and were kind to the HIV/AIDS patients. Some even went to the extent of offering advice on matters unrelated to the treatment that brought them together, which shows a desire to offer holistic care to the patient. According to Dapaah (2012), a good number of HIV/AIDS patients reported being received warmly, courteous treatment, advice, and even financial support being received from the nurses who handled them every time they went to the health facility. Some nurses offered to work overtime in a bid to provide care for clients who arrived late.
The effect of this kind of treatment on the patients is very positive because they always looked forward to the next appointment at the clinic. Some nurses sought to encourage defaulters in the different care programs by embracing those who strictly adhered to the programs and praising them in public. Such characters were also used as role models for others to emulate. This kind of relationship between nurses and HIV/AIDS patients espouses the holistic and comprehensive care ideas outlined by the early nursing theorists.
Therefore, it can be deduced that although Ghanaian nurses have been touted as harsh, arrogant, and insensitive to the needs of their patients, some are committed to the guidelines provided in the existing body of nursing knowledge. These are especially found among the HIV/AIDS caregivers as the disease is still being held with stigmatization such that if its victims are mistreated, it could easily lead to deterioration of their health conditions. Since this aspect is not desirable, HIV/AIDS care nurses bear the responsibility of attracting and retaining its victims through courteous treatment to make them feel loved and worthy in society.
This essay sought to explore the foundational philosophical sources and experiences that have influenced and continue to influence nursing knowledge and skills with relevance to caring for HIV/AIDS patients from a Ghanaian perspective. HIV/AIDS, even though it is no longer an acute illness, is still a worldwide pandemic, and caring for its victims gets complicated by the day. Existing nursing knowledge has developed over time from philosophies and experiences of early nursing leaders such as Florence Nightingale, Jean Watson, Imogene King, Dorothea Dix, and Florence Wald among others. However, in Ghana nurses are generally touted to be harsh, arrogant, and discriminative towards patients despite the existence of noble ideas expected to guide their conduct. Only a few nurses in Ghana, especially those who care for HIV/AIDS victims, show commitment to the ethos of the nursing profession because, in the African context, victims of this disease are still treated with so much stigma that they seem to find solace in the nurses’ courteous treatment. It also encourages them to continue seeking care through the various care programs that exist in the country.
Allen, D. (2004). Re-reading nursing and re-writing practice: towards an empirically based reformulation of the nursing mandate. Nursing Inquiry, 11, 271-283.
Armstrong, D. (2009). Origins of the problem of health-related behaviors: A genealogical study. Social Studies of Science, 39(6), 909-926.
Björnsdóttir, K. (2001). Language, research and nursing practice. Journal of Advanced Nursing, 33(2), 159-166.
Caine, V., & Lavoie, M. (2011). Places inarticulately close. Nursing Philosophy, 12(3), 229-235.
Camargo, P., Cameron, L., & Smith, G. (2012). Neoliberal Oriented Health Care System Answer to Global Competition or a Threat to Health Equality for People with Chronic Illness. Advances in Nursing Science, 35(2), 166-181.
Cameron, B. L. (2006). Towards understanding the unpresentable in nursing: Some nursing philosophical considerations. Nursing Philosophy, 7, 23-36.
Cameron, B., Ceci, C., & Santos, A. (2011). Nursing and the political. Nursing Philosophy, 12, 153-155.
Canguilhem, G. (2008). Knowledge of life. New York, NY: Fordham University Press.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23.
Code, L. (2006). Ecological thinking: the politics of epistemic location. Oxford, UK: Oxford University Press.
Dapaah, J. M. (2012). HIV/AIDS treatment in two Ghanaian hospitals: Experiences of patients, nurses and doctors. African Studies Collection, 38, pp. 85-93.
Daves, R. L. (2005). The practice of the everyday in the literature of nursing. Journal of medical humanities, 26(1), 7-21.
Dickoff, J., & James, P. (1968). A theory of theories: A position paper. Nursing Research, 17(3), 197-203).
Donaldson, K., & Crowley, M. (1997). The discipline of nursing. In L. Nicholl (ed.), Perspective on Nursing Theory (3rd ed.), (pp. 235-246). Philadelphia, PA: Lippincott.
Drummond, J. S. (2004). Nursing and the Avant-Garde. International Journal of Nursing Studies, 41(5), 525-533.
Fawcett, J. (1978). The relationship between theory and research: A double helix. Advances in Nursing Science, 1(1), 49-62.
Foucault, M. (1982). Is it really important to think? An interview (translated by Thomas Keenan). Philosophy & Social Criticism, 9, 30-40.
Gadamer, H. (1996). Theory, Technology, Praxis. In J. Gaiger & T. Walker (Eds.), The enigma of health (pp. 2-30). Stanford, CA: Stanford University Press.
Georges, J. M. (2008). Bio-power, Agamben, and Emerging Nursing Knowledge. Advances in Nursing Science, 31(1), 4-12.
Harding, S. (2004). A socially relevant philosophy of science? Resources from Standpoint Theory’s controversiality. Hypatia, 19(1), 25-47.
Holzemer, W. L. (2008). Nursing care theories, a heritage for constructing our future. [Theories de soins infirmiers, un heritage pour construire notre futur] Soins; La Revue De Reference Infirmiere, 724, 52.
Judd, D. (2009). A History of American Nursing: Trends and Eras. Burlington, MA: Jones and Bartlett Publishers.
McCready, J. (2010). Jamesian pragmatism: A framework for working towards unified diversity in nursing knowledge development. Nursing Philosophy, 11(3), 191-203.
Mill, E., & Ogilvie, D. (2002). Ethical decision making in international nursing research. Qualitative Health Research, 12(6), 807-815.
Mol, A. ( 2006). Proving or Improving: On Health Care Research as a Form of Self-Reflection. Qualitative Health Research, 16, 405-414.
Pols, J. (2006). Washing the citizen: washing, cleanliness and citizenship in mental health care. Culture. Medicine and Psychiatry, 30, 77-104.
Pyyhtinen, O., & Tamminen, S. (2011). We have never been only human: Foucault and Latour on the question of the anthropos. Anthropological Theory, 11(1), 135-152.
Radcliffe, M. (2000). Doctors and nurses: new game, same result. British Medical Journal, 320(7241), 1082-86.
Rafferty, A., Allcock, N., & Lathlean, J. (1996). The theory/practice ‘gap’: taking issue with issue. Journal of Advanced Nursing, 23, 685-691.
Risjord, M. (2010). Nursing Knowledge: Science, Practice and Philosophy. Oxford, UK: Wiley-Blackwell.
Santos, A. (2005). Toward a north-south dialogue: Revisiting nursing theory (from the south). Advances in Nursing Science, 28(1), 17-24.
Scott, W. (1991). The evidence of experience. Critical Inquiry, 17(4), 733-797.
Shaw, M. (1993). The discipline of nursing: Historical roots, current perspectives, future directions. Journal of Advanced Nursing, 18, 1651-1656.
Sochan, A. (2011). Stance and strategy: post-structural perspective and post-colonial engagement to develop nursing knowledge. Nursing Philosophy, 12(3), 177-190.
Weinberg, D. (2006). When little things are big things: The importance of relationship for nurses’ professional practice. In S. Nelson & S. Gordon (eds.), The Complexities of Care: Nursing Reconsidered (pp. 30-43). Ithaca, NY: University of Cornell Press.