Nursing and Daoism: Wading in the River of Practice

Philosophy in Nursing Practice

Amid the stress and chaos of everyday life, it is difficult for a nurse to contemplate philosophy and integrate it into practice. However, philosophical principles and knowledge ground our actions and thought in everyday practice. The nursing profession in particular credits philosophy for moving our practice forward. “[N]ursing scholars have advanced our science and practice based on its reliance on philosophy of science and the evolutionary scientific method” (Dahnke & Dreher, 2011, p. 55).

Nurses are very proficient at skills; their daily care is a carefully crafted art of interventions and outcomes. However, a philosophical nurse examines his or her practice with complexity to understand human processes and deepen thinking through the teachings of philosophy. Philosophy elevates our physical competencies and skills to the more complex matrix that it really is. Treatments may look simple when viewing individual steps; however, healing as a whole process is more philosophical.

Action without foundational knowledge in philosophy and ethics can lead to automatic actions focused on the physical being of the person receiving care and can be a barrier to caring for the whole person as well as to understanding the importance of the healing relationship. If “just praxis” means lack of critical reflection, moral reasoning is definitely weakened and, in the worst case scenario, may even be absent.

Daoism

Throughout history, many philosophers have maintained that experiences and phenomena are parts of a whole, a greater process or structure. Events in life may be but one glimpse of a larger picture. When one thing changes, all things change. Ancient Eastern philosophers through 21st Century thinkers have upheld the idea that the whole is greater than the sum of its parts. Daoist teachings are the vehicles for understanding this theory and applying it to practice. When nurses care for the individual, family, and community, every piece is part of the bigger whole.

Chinese philosopher Lao Tzu (c. 600 BCE) is credited with being the “Old Master” whose thoughts on the Dao, or “Way” of life, have become some of the most influential writings in Chinese history (Soccio, 2007). “The term 'Daoism’ is associated with assorted naturalistic or mystical religions” (Hansen, 2013, para. 1). “Definitions of Daoism are controversial because of the complex twists in its development as it played its role in the long history of China” (Hansen, 2013, para. 4). “Traditional accounts of Daoism deal with these areas of overlap: metaphysics: [things above the physical] and ethics” (Hansen, 2013, para. 9). “Daoism, which embodies the harmony of opposites [(yin/yang)], regulates natural processes and nourishes balance in the universe and is a cosmology and philosophy about the nature of the universe” (Kao, Reeder, Hsu, & Cheng, 2006, p. 93).

Daoism is the concept and practice of the Dao (also spelled Tao). The word Dao is most commonly translated as the “Way” (Soccio, 2007). There are no literal translations of the word from Chinese into English, so the word Dao is often expressed in synonyms, such as “course,” “method,” “practice,” “fashion,” or “technique” (Hansen, 2013). These words all relate to nursing preparation. Within the “Way,” there is no single divine or religious path but rather a universal “Way” to follow life, in harmony with the universe. To resist the “Way” is to go against Daoist thinking—swimming against the current. Daoism explains that “there is a single, constant, correct way of life that cannot be expressed or presented in practices, rules, narratives, maps, examples, songs or any other human or social form of communication and advocacy” (Hansen, 2013, para. 25), “ … akin to what we would consider the [devotions] of science. It is the ways things reliably (constantly) have happened and will happen” (Hansen, 2013, para. 18). This way of life emulates the natural ebb and flow of water. “Water is fluid, soft, and yielding. But water will wear away rock, which is rigid and cannot yield. As a rule, whatever is fluid, soft, and yielding will overcome whatever is rigid and hard” (Tao Te Ching, as cited in Hesselink, n.d.).

In explaining the “Way,” Lao Tzu says that “by doing nothing great deeds are accomplished.” He does not mean, “by sitting like a lump, no matter what, great deeds are accomplished. He means that by taking no contrived, calculated, 'controlling’ action, we are most likely to contribute to improving conditions around us” (Soccio, 2007, p. 34). An analogy to the phrase “Go with the flow” is appropriate here; nurses in practice may find this analogy helpful during tumultuous times. It gives the practitioner freedom to experience a range of emotions. Just as the tides of water rise and fall, the nurse experiences empathy, compassion, sadness, enlightenment, gratitude, and fulfillment. Water is strongly represented in Daoism, which is often referred to as the watercourse way. Daoist lessons explain that water is “the highest good” and that followers should “emulate water” and live life in harmony with nature (Cooper, 2012, p. 64). If a boulder is in the way, instead of moving it, the teachings of Daoism instruct us to go with the flow: The water will move under and around the boulder, and in time, the boulder will erode into a pebble (Hansen, 2013). This cements the Daoist teaching of wu-wei— effortless action, or inaction is action.

In today's practice environments, nurses may experience demanding work settings as the norm; with a Daoist approach, nurses can ask themselves, “How can I get into the rhythm of this system rather than fight against it?” Upon further inspection, the nurse understands, “I do not have to change the whole system, I just have to understand myself and my practice.” If we do not care for ourselves, we cannot care for our patients. The rapid rhythm of health care is the new norm; nurses need to understand what options we have for responding to and coping with stress. Different practice areas have different flows and norms—for example, an emergency room as compared to a hospice setting. Understanding self, knowing one's practice limitations, and accepting what stressors one can handle in a given situation is practicing the “Way.”

Daoism contains representations of everything being parts of the whole, each part dependent on one another for existence. “The very essence of being a part requires a whole to be a part of, and there can be no whole without parts” (Soccio, 2007, p. 25). We typically view life as single events and occurrences within our existence; however, Daoism teaches that we are part of a bigger picture, the “Way.” When “we experience life as discrete [singular] events we are unenlightened and confused; unaware that the flow of Dao cannot be 'trapped’ we identify with particularities” (Soccio, 2007, p. 25). The “watercourse way” is a relevant concept for today's nurse, reinforcing that the sum is greater than the parts of the whole. Chinese philosophy continues to teach us and actualizes what nurses already know and experience.

Application to Nursing Practice

The baccalaureate-prepared nurse learns to look at the whole environment of the patient, the family, and the community as the client. This level of practice uses systems theory and Daoism: The sum of the patient experience is greater than the parts. We can liken this to a ripple effect: Whatever happens to the patient affects the whole ecosystem of that patient. The path may change, but being accepting of this ebb and flow helps us to practice more harmoniously.

So how might a nurse's practice emulate the Dao and introduce empathic attachment to this journey? Recall that one synonym for Dao is “practice.” The Daoist representation of the boulder analogy can be applied to our practice in actual or potential illness. Unable to move or eradicate illness completely, the practitioner strives to make illness a pebble, dormant and manageable in the tide of life. The river is the whole human being; it represents life, and its flow represents the “Way.” The river is greater than the lakes and streams that feed it. A person's life events may be small streams or branches of the river, but the representation of life itself is the flowing river. “Health means equilibrium, a harmony between the microcosm of person and the macrocosm of the universe. Health, through harmony, is kept and even improved … if there is disequilibrium and disharmony, then illness follows” (Kao et al., 2006, p. 96). The concept of yin/yang is strongly represented in Chinese teachings as cosmic opposing forces of the universe working in harmony (Soccio, 2007).

The natural “Way” of existence is a predetermined metaphysical destination. The rivers of life are raging waters and still ponds. “During the disharmonious period, nursing can be characterized as recovering harmony or compensating disharmony; during the period of harmony, nursing intentionally, with mindfulness and compassionate openness, concentrates on maintaining, allowing, and promoting the harmony” (Kao et al., 2006, p. 97). The practitioner cannot fight the flow of the river, just as the practitioner cannot prevent illness from occurring. We can only supply the interventions to balance equilibrium and maintain harmony. There will be boulders, pebbles, and obstacles; however, the practitioner who realizes that these obstacles are part of the “Way” will find understanding and deeper knowledge in caring for patients. Nurses must look outside their specific places of practice and realize that an illness event for a patient may be a small part of a bigger picture. “Thus, a person's health is not merely his or her own business but a loop to the overall health of other people and the environment. [Consequently] each person's health contributes to the subtle harmony of the whole universe” (Kao et al., 2006, p. 96).

For example, a nurse obtaining an admission history from a patient before an elective surgical procedure inquires about the patient's lifestyle. The patient responds that she holds a doctoral degree, works full-time in a highly regarded career, is divorced with two young children, and recently experienced paralysis of her right arm, which has led to the scheduled surgery. Upon reflection, the nurse realizes that these lifestyle stressors are impacting not only the patient but also those around her, particularly her young children and her workplace. The nurse takes the time for a caring and therapeutic conversation with the patient to acknowledge the stressful life circumstances that she is involved in.

Conclusion

The teachings of philosophy both past and present have clear representation in nursing practice. The nurse who seeks to understand at a deeper level can elevate his or her practice and give deeper meaning to patient and self-experiences. In the scenario presented, the nurse recognized that the patient is experiencing complex life events and stressors. With philosophical theories to guide practice, and with persistence toward self-inquiry, the nurse can consider the patient more fully and can reflect on his or her practice.

Through an examination of Daoism, the nurse understands a flowing river to represent the “Way” and strives for equilibrium to attain harmony. Experiences are but parts of the whole, a larger existence that warrants our constant examining. Let this reflection be the first step in what is a thousand miles of experiences. Through Daoism, our thoughts are flowing, our minds are accepting.