After reviewing several philosophers, I decided to choose one from the 17th century, the beginning of the era of the Enlightenment. The Enlightenment was a time of innovation and the discovery of new ideas and concepts. Knowledge was learned and gained. Many philosophers arose during this time with different opinions and ideas. John Locke was one of the renowned philosophers of this time who paved the way for empiricism.
John Locke was born on August 29, 1632 in Somerset, England and died in October 1704 (Rickless, 2014 p. 2). He studied medicine and science at Oxford University, earning a medical degree. He interacted with Dr. Thomas Sydenham from whom he learned that the best way to study any disease is by observation of its development and the effects of treating it in various ways (Rickless, 2014, p.4). He investigated the function of respirations, researched the various colors of blood, and conducted experiments with barometers, thermoscopes and hygrometers to better understand the weather and its potential relationship to disease (Rickless, 2014, p. 3).
Locke became very interested in political philosophy. He suggested that the main cause of all political problems is the nature of human beings. He believed that in order to understand the nature of human beings that we must first discover how human beings arrive at their knowledge of the world (Strathern, 1999, p. 33). He wanted to know how we come by knowledge and what precisely knowledge was.
Locke appreciated Descartes method in doubting the senses, but disagreed with his reasoning and deduction as a method of arriving at the truth. Locke believed that the only way to arrive at the truth about the world is only by scientific method (Strathern, 1999, p. 29). The French philosopher, Pierre Gassendi influenced Locke in his beliefs that all knowledge was based on sensory perception (Strathern, 1999, p. 31).
Locke's, masterwork, An Essay Concerning Human Understanding, laid out his philosophical ideas. He believed that we start our life with a tabula rasa, meaning a blank sheet (Strathern, 1999, p. 51). Babies are born with their mind in a blank state, and as the child develops, they then gain human knowledge, which is derived from outer experience and reflection. He believed in many empiricist principles. He believed that the way our mind collects, organizes, and makes judgements all come from the use of our senses. Everything we know and the knowledge we accumulate throughout our life comes from these experiences.
Locke went on to continue his thoughts in the second part of his masterwork, An Essay Concerning Human Understanding Book II: Ideas. In this book he states, no man's knowledge here can go beyond his experience (Locke, 2001, p. 59). Locke focuses on the ideas that make up our empirical knowledge (Strathern, 1999, p. 54). He believed our experiences could be separated into sensations and reflections. Sensations were experiences that happened when the senses were affected by something externally. Reflections were experiences that happened when the senses were affected by something internally (Rodgers, 2005, p. 57). Locke then went on to say that our experiences generated ideas in our mind, which could be divided ideas into simple ideas and complex ideas. Simple ideas were the the ideas that only involved one sense, whereas complex ideas were the ideas that consisted of multiple simple ideas, which created one vivid idea (Rodgers, 2005, p. 57).
Locke also believed in causality and how knowledge strictly comes from sensory experience. These experiences produce impressions in our mind, which then turn into ideas. Locke then realized that not everything our senses tell us can be trusted. He then went on and distinguished between primary and secondary qualities of objects (Strathern, 1999, p. 54-55). Primary qualities are qualities that physical objects themselves have. These qualities are not in our mind, such as the height or shape of an object. These qualities are perceived the same for everyone. Secondary qualities are qualities that are not real. These qualities are simply ideas in our mind and how an individual person perceives something, such as the color of an object or the smell of a flower. These qualities are very subjective and cannot be trusted. Metaparadigm
The four metaparadigms of nursing consist of the individual, environment, health, and nursing. Even though nursing did not exist during John Locke's time, these concepts can be seen in his theories and philosophical beliefs. John Locke wrote an Essay on Human Understanding and the Two Treatises of Civil Government. These major works of literature highlight Locke's ideas and beliefs.
The individual concept can be seen in John Locke's ideas of identity and diversity. He stated that the self is that conscious thinking thing, whatever substance made up of (whether spiritual or material, simple or compounded, it matters not), which is sensible, or conscious of pleasure and pain, capable of happiness or misery, and so is concerned for itself, as far as that consciousness extends (Locke, 2001, p.199). The self, therefore, depends on our individual consciousness. He believed our consciousness was independent of our physical body. This can be seen in a patient who had to amputate their foot due to complications of a foot ulcer caused by their diabetes. This foot is therefore no longer part of this person's consciousness. Locke also believed that if consciousness is removed, the substance is no more itself. He stated that the immaterial thinking thing may sometimes part with its past consciousness (Locke, 2001, p. 201). This can be seen in a patient who has Alzheimer's. This patient may not remember anything from his/her past, so this patient according to Locke, would therefore be a different person than his/her past self.
The environment concept can be seen in John Locke's ideas on property. In the Second Treatise of Civil Government, he states though the earth, and all inferior creatures, be common to all men, yet every man has a property in his own person: this no body has any right to but himself. The labour of his body, and the work of his hands, we may say, are properly his. Whatsoever then he removes out of the state that nature hath provided, and left it in, he hath mixed his labour with, and joined to it something that is his own, and thereby makes it his property (Locke & Shapiro, 2003, p. 111) Everybody, therefore, owns their own body. Each person can also acquire property by using their body to do labor, so if someone puts work into the environment that is not theirs, such as in farming, that person therefore owns that property, as well.
The health concept can be seen in John Locke's theory that every idea that we have comes from our experiences. Every person has their own individual experiences in life, which shape who we are and determine what we know. Based on these individualized experience, we come up with secondary qualities, which determine how we perceive life and the way certain factors make us feel. For example, a child that touches a hot stove will feel pain from the burn that they just received. This child then may associate this feeling of pain with not being healthy.
The nursing concept can be seen throughout John Locke's life through his interest in medicine. In 1666, John Locke delivered medicinal waters to Lord Ashley Shaftesbury in Oxford (Uzgalis, 2018). Through this encounter, John Locke and Lord Shaftesbury developed a rapport. In 1667, Locke became the personal physician for Lord Ashley Shaftesbury and his family. While living at his house, he met Dr. Thomas Sydenham who taught Locke that the best way to study any disease is through observation of the disease progression and the effects of different treatments for the disease (Rickless, 2014, p. 4). While Locke was staying with Lord Shaftesbury, he developed a tumor that Locke was able to successfully cauterize and drain, which saved his life. John Locke's medical knowledge enabled him to perform direct medical care to save Lord Shaftesbury's life.
The four metaparadigms of nursing are the individual, environment/society, health, and nursing. Every nurse should have his/her own beliefs regarding these four concepts. Our beliefs and values shape how we practice nursing on a daily basis. Each metaparadigm is vital when we provide nursing care. According to the American Nurses Association (2010), nursing is defined as the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations. This definition touches on each of the four concepts. These four concepts affect each other.
I believe the individual concept is the person whom is receiving the nursing care. This not only includes the physiologic factors and the disease state, but it also includes spiritual, social and psychological factors as well. Looking at the patient as a whole and evaluating all aspects of their needs is important when caring for them. Each person is unique and should be treated with individualized nursing care. Caring for your patient will usually include relevant aspects of that patient's life, such as the patient's family and other people important to the patient.
The environment concept I believe is something either internally or externally that impacts a person's health and recovery. Many people would think the environment is simply just the hospital floor, but there is much more to the environment than that. The patient may be influenced internally by their spiritual and cultural beliefs. The patient may also be impacted externally by their social ties, family and friends. They may even be influenced by their home life, school life, or workplace. There are many stressors in our environment that can negatively impact our health. While the patient is under our care, we must assess the patient's environment, identify any safety hazards and implement safety practices to prevent further injuries. Ultimately, when a person is under our care, we want to make sure that the environment that they are in is comfortable and holistic.
The health concept is very subjective and depends on everyones own perspective. I believe health is the state of an overall well being in every aspect of life, including physically, emotionally, spiritually and mentally. Some people may consider health as just the absence of disease and illness. What I may deem to be healthy, someone else may think that it is unhealthy. One person may consider themselves healthy because they are able to perform their activities of daily living and are able to walk. Another person may consider themselves healthy if they do not experience pain today.
The nursing concept I believe consists of the act of nursing and performing nursing interventions. It encompasses the care of people, families and communities of all ages. It involves the promotion of health and prevention of illness. The nurse uses his/her knowledge and skills for direct patient care. The level of care given to the patient will depend on the needs of the patient. Establishing a rapport with the patient will help build a therapeutic nurse-patient relationship where there is mutual respect and open communication. Nursing involves empathy and as a nurse we act as the patient's advocate, friend, therapist and much more. Sometimes offering a person an ear to talk to is all that they need.
Nursing today shows how empiricism has greatly influenced nursing practice. Medical professionals use John Locke's theories everyday. For example, a medical provider working with a cancer patient may look at the patient's primary qualities, such as the shape and size of the tumor. Then based on the outcome, the medical provider can decide what the best treatment plan would be for that patient. Professional nursing takes a more holistic approach when caring for patients. Nurses will want to see the secondary qualities a patient has, such as the pain or fear the cancer is causing the patient. Nurses treat patients as a whole, including not only the physiologic factors, but also the spiritual, sociologic, and environmental factors as well.
I think evidence-based practice is important to consider when caring for patients, however empirical based numbers may not always apply to every single patient. Boiling everything down in nursing practice to empiricism is not the best way. Each person is different and has different situations. Every patient cannot be treated the same way. The application of evidence to practice by any discipline requires an understanding of the array of personal meaning contexts that influence patient values and, therefore, patient decisions (Grace & Powers, 2009). The United States is a melting pot of people containing many different cultures, which have different beliefs.
As medical professionals we need to take into account each individuals specific needs, desires, and fears. Besides evidence-based research, we need to take into account knowledge that was obtained from clinical experience and patients' experiential knowledge (Rycoft-Malone et al, 2004). No one knows us better than ourselves. Listening to patients is very important when determining the proper interventions and care. Patients may have had an adverse reaction to a medication that evidence-based research showed to be great for their specific condition. Outliers do exist and listening to the patient in this case would be more important than what the empirical research states.
Overall, patients have the right to decide on the type of care that is right for them. It is the medical providers responsibility to educate the patient on treatment options, potential outcomes, risks, benefits and cost of the treatment, so that patients are able to make informed decisions (Deber, 1994). In conjunction with the information provided by nurses, they have the ability to choose the sort of care that is best for them (Porter & Morrow, 2011). For example, a medical provider working with an elderly patient battling prostate cancer might suggest that the patient have a prostatectomy based on evidence-based practice. On the other other hand, the patient may want to see if the tumor grows and just keep a close eye on it. Some patients may not want to undergo the surgery, especially if the patient is elderly. Other patients may feel differently and want the cancer completely out of them. The patient has the right to think about the options that they have and choose a treatment plan that they feel is the most appropriate for them.
All in all, it is undeniable that John Locke is still known as an influential philosopher from the Enlightenment era, who helped pave the way for empiricism. John Locke and others from this period, have definitely showcased how and why evidence is a necessary component in determining causes. While evidence-based practice has and continues to be vital in nursing practice, nursing strongly proves that other practices are necessary too. Furthermore, nursing couples the realistic approaches established by John Locke with the emotional aspect that prove to be just as supportive.
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