doi: 10.1111/nup.12011

Conference report

Nursing in The 21st Century: Perfect Practice, Imperfect Practitioners Nursing practitioners, teachers, and academics from around the world gathered on September 2012 for the 16th International Philosophy of Nursing Conference hosted by the University of Leeds. It was a hospitable, comfortable, and above all friendly event that welcomed novice presenters as much as esteemed keynote speakers. The focus of the conference was Nursing in the 21st Century. This was my first adventure in the lovely city of Leeds, and as someone unused to the ways of philosophy, I found the programme highly engaging and relevant to the practice of nursing and the experience of patients and carers. From planned interventions by cyborgs to gut responses to human suffering, from local conundrums to global possibilities, the broadest discussion of the human experience of nursing care was aired in keynote presentations and concurrent session discussions as well as in the corridors (and in the bar, of course). There is a general acknowledgement that nursing as a practice and as a professional career remains in a state of constant change. However, there is a range of opinion as to how social, technological, and organizational change in nursing should, could, or might alter the experience of being nursed or of being a nurse as the 21st century unfolds. It occurred to me that the bar of our expectations constantly rises; we desire excellence and perfection in all our experiences from family celebrations to the goods that we buy, and why should we settle for less when it comes to the health care we need. Prof Dawn Freshwater (University of Leeds, UK) set us off with the question: what is a nurse? Is it just about practice or is it an identity, a state of mind? Clearly, this does matter in the wider context and influence of nursing and nurses, of those who educate, undertake research, manage nursing services, or who commentate upon or otherwise influence nursing and its direction. Quoting from Havi Carel’s moving personal account in her book Illness, Professor Freshwater brought this question into sharp focus with a

© 2013 John Wiley & Sons Ltd Nursing Philosophy (2014), 15, pp. 57–59

reminder of the expectation that being cared about is just as important as being cared for. Successful nursing is more than meeting the practical needs of a service user, but is also about the individual knowing that you can, at least in part, understand the significance of the illness event for them and for those who care about them. It was good to be reminded that reflective practice and self-awareness are essential to interactions that seem common or routine, whereas to patients, even the most ordinary everyday event can have extraordinary meaning and significance. Dr Catherine Green (Rockhurst University, USA) asked, ‘are we a one or a many?’ Discussing illness as biographical disruption, she suggested that nurses become incorporated in the patient’s biography in the way that they become incorporated into ours. Despite the passage of time and the expansion of nursing roles, the relational aspect of nursing is still wanted and needed. Dr Ann Gallagher’s (University of Surrey, UK) keynote focused our attention on the concept of dignity, arguing that human caring has always been routed in humanity but that relationships within care today are not entirely under the nurse’s control. Managerial and structural changes in healthcare provision have a direct effect on moral and ethical nursing practice. Thinking and acting ethically are key skills for nurses, and are the real challenge in the increasingly complex field of health and social care in the 21st century. Health care is changing fast, so does this mean that in a world where care is ‘quicker’ and for the ‘sicker’ that nursing must become a‘faster’ profession? Like the slow food movement, do we need to think about ‘slow nursing’? This is especially relevant in the field of care of the older person where I am mindful that illness may advance quickly but recovery is often slow. In the 21st century, can nursing still be about slow-paced interventions,time to care,time to listen,or is it all about a care pathway to the nearest exit from dependency on health care services? A focus on the essence and essential aspects of nursing are like comfort food to the hungry, but are in



Conference Report

danger of ignoring those individualistic motivations and aspirations of the practitioners themselves. Dr Martin Lipscomb (UWE, Bristol, UK) reminded us that as it stands, the history of nursing (in developed countries at least) has been one of change and ‘splintering’ into fields of practice into separate professions (for nursing and midwifery in some countries). This is often driven not only by the quest for enhanced competence, but also for better status and improved conditions of pay and work. These are changes that belie the homogeneity and stability or service mandate of a changing career of practice. It was a useful reminder of the reasons why some areas of practice thrive, have no problems with recruitment, and the patients’ confidence and experience are high, and why other areas flounder and struggle to recruit and retain suitable staff or to improve the experience of vulnerable people. It is all very well to be high minded and idealistic about one’s nursing identity or outlook, but for most, it is a job that is interesting and rewarding at times, but is also hard work, frustrating, exhausting, and thankless on occasion. No one wants to admit that there are times when it is only the need for the pay packet and limited alternatives for work that has kept us going.After all, nursing is not something that everyone wants to do or can do, and not every nurse can always achieve perfection in either identity or state of mind every day and in every circumstance. Linking competence and power in nursing, Dr Derek Sellman (Alberta, Canada) argued that the development of competence is much more complex and fragmented than the current healthcare services would like to own. Dr Sellman called for honesty in our discussions about what (achieving) competence (in the full skill set required to give safe, effective, and dignified care) is really about. Because we work with human beings, change is the constant in nursing. Stability is delusional; therefore, competence is never a fixed state but one of perpetual striving and aspiration to do better. However, in the development of the nursing cyborg, we see another expression of our desire for perfection in practice. Susan Barnes and Dr Theodore Metzier (Oklahoma City, OK, USA) brought us an imaginative and amusing dialogic presentation to raise issues of care for older people by the idea of a

human cyborg, more conservatively termed Human Robot Interaction (HRI). Work is under way to make this a reality in many countries (Japan springs to mind), and the interface between computer technology and health care is well established and generally rolls out uncontested as a useful and good thing for patients across the globe. We are familiar with the philosophical issues raised in, for example, Star Trek, as the crews of various star ships encounter the functional Borg species (7 of 9 was the most engaging), and if you are as old as me, the adventures of the Six Million Dollar Man! We were fresh from enjoying the achievements of the paralympians in London 2012 and were very much open to having preconceived ideas of technologically enhanced human performance revolutionized. But when it comes to philosophical ideas of nursing, of ethical actions upheld or undermined, of dependency or confused relationships, our ideas about the cyborg reflect many of our ideas about nursing and its values in the 21st century.The question I was left with was ‘will a nursing relationship with a robot have advantages over a flawed and imperfect human?’ This conference (as it should) asked and debated some really important philosophical questions. The experience (for me) was strengthened in debate, and when opportunities arose for direct application of theory to nursing practice. It may be that that all nurses are philosophers.After all, successful nursing is a complex combination of thinking and doing. It is about the nursed and the nurse; it is about practice, and about a state of mind. In the 21st century, it is also about the struggle for competence and perfection beyond ‘to do no harm’, and ‘dignity’, beyond ‘competence’ even. I enjoyed my adventure in nursing philosophy and I loved Leeds; time to think and to question is essential, and wherever nursing ends up at the conclusion of the end of the 21st century, I hope that the International Philosophy of Nursing Society will still be helping us to do that! I have provided only the briefest insight into the work and ideas of those who attended, but I am comforted that we can keep in touch with the journal Nursing Philosophy (now digital and online) and

© 2013 John Wiley & Sons Ltd Nursing Philosophy (2014), 15, pp. 57–58

Conference Report

through the society’s website. I am looking forward to subsequent International Philosophy of Nursing conferences, more adventures in the future of nursing with colleagues and new friends from around the world!

© 2013 John Wiley & Sons Ltd Nursing Philosophy (2014), 15, pp. 57–59

Melody Carter PhD RGN Senior Lecturer: Nursing, UWE Bristol, Department of Nursing and Midwifery, Faculty of Health and Life Sciences, Bristol, UK


Nursing in the 21st century: perfect practice, imperfect practitioners.

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