The Concept of Wisdom in the Modern Nursing Literature
A review of modern nursing literature has demonstrated that the notion of wisdom does not appear to be a major one in the profession. Most academic articles from various spheres of nursing that have the words “wisdom” or “wise” in their titles primarily use the words to refer to extensive knowledge and mastery of professional skills and competencies; therefore, what many authors mean by wise nursing is generally good nursing, i.e. something that demonstrates high quality, without specificity on what exactly is good about it. The purpose of the research, however, was to identify the use of the word “wisdom” as something designating a particular concept, which is why authors and articles were addressed that used the concept of wisdom meaningfully and pursued explaining what it meant for a nursing care provider to be wise.
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One of the prominent scholars in this area is Susan A. Matney, a specialist in health care informatics and a nurse with more than 30 years of experience. She authored several works on the concept of wisdom in nursing, and her recent study conducted in collaboration with her colleagues was dedicated to summarizing the results of many scholarly findings (including her findings) on the notion of wise nursing and comparing systematic understandings of the concept to wisdom models from other disciplines, including philosophy and psychology. Matney, Avant, and Staggers (2016) state that, in nursing research, wisdom is often regarded as “an abstract idea, an end-point or characteristic, something applied in, yet separate from practice” (para. 6); therefore, a major complication that the authors identify in terms of the concept of wisdom is that, in nursing literature, it is mostly not linked to practice or certain guidelines on what behaviors a nurse practitioner should adopt to become wiser. To address this complication, the authors emphasize the wisdom-in-action framework that regards wisdom as a set of practical requirements and characteristics.
In their attempt to link wisdom to nursing performance, Matney et al. (2016) use an earlier definition that states that wisdom is “the application of experience, intelligence, creativity, and knowledge, mediated by values, toward the achievement of a common good” (para. 13). Further, the authors identify ten characteristics associated with wise nursing practice and ten antecedents to wisdom in nursing; both the characteristics and the antecedents are derived from scholarly wisdom theories. The characteristics were rich factual knowledge, rich procedural knowledge, lifespan contextualism, knowledge mastery, stressful situation or management of uncertainty, judgment, decision, application, reflection, and learning; knowledge mastery was the one used in the largest number of wisdom models, and the character suggests that a practitioner is proficient in referring to existing theoretical knowledge he or she has. The antecedents were data, information, age, education, social interaction, values, relativism, and tolerance (these three combined as one antecedent), cognition, openness to learning, mentors/role models, and life experiences. The ones that had been mentioned the most in wisdom models were education, openness to learning, and values, relativism, and tolerance. It is evident that the authors explored the concept of wisdom as complicated and comprised of many components, some of which (such as education and values) had been explored by Christian scholars in previous periods.
One of the studies to which Matney et al. (2016) referred was a study of so-called clinical wisdom conducted by Haggerty and Grace (2008). These authors claim that the concept of wisdom in nursing lacks a proper definition, too; however, they identify three components of wisdom from psychological and philosophical models applicable to the delivery of nursing care. The first component is pursuing both the good of another (in the context of health care, a patient) and the common good. The second component is approaching problem-solving with both intellect and emotion. The third component is applying “experience-based tacit knowledge” (Haggerty & Grace, 2008, p. 236), e.g. the ability to identify and address unmet needs based on extensive situated experience. The authors also suggest that the measurement of wisdom in nursing practice goes beyond the professional goals of a nurse and takes into consideration the contribution made to the achievement of the common good. Examples of such contributions may be community health programs, promotion of engagement in care, or patient education campaigns for external audiences.
The aspect of serving the common good was emphasized by Wiedenbach (1970), too, as she described a prescriptive nursing wisdom theory, i.e. a theory of what a nurse should do to be wise, and called upon nurses to realize their potential for service to humankind. An influential nursing theorist and a prominent nursing educator, the author reflect on the ability of some nurses to resolve difficult real-life clinical issues more successfully than other nurses resolve such issues. For example, a patient refuses to have lunch and demonstrates aggressiveness; one nurse tries to quiet the patient but faces violent opposition, while another nurse manages to quiet the patient and induce him or her to have lunch. Wiedenbach (1970) believes that the second nurse demonstrates “a combination of lore, wisdom, and concern” (p. 1058), which is the reason for successful problem-solving. The author suggests three main considerations applicable to measuring wisdom in nurses: the dignity, scope, and stature they give to the practice, the internalized understanding of the purpose of care delivery, and the promotion and development of their potentials for improving nursing practice, both their own and that of their facilities and their profession in general.
One of the nursing areas in which the concept of wisdom can be applied in nursing education and some researchers addressed this area particularly. For example, McKie et al. (2012) argue that there is a growing interest in the notion of wisdom among nursing theorists and practitioners, which is why the notion should be incorporated into the curricula of nursing education programs. On a wider scale, the authors explored two understandings of wisdom: practical knowledge and recognition of contextual factors. The former refers to not only having strong knowledge but also being able to apply it to real-life clinical situations. The latter is rather challenging; it suggests that a wise nurse should demonstrate the ability to profoundly understand all the factors that contribute to a given real-life clinical situation and propose solutions based on insight into the situation. In the context of education, it remains unclear whether wisdom can be taught and learned, or practical experience is required to become a wise nurse.
A different approach was employed by a nursing theorist Patricia Benner whose works were reviewed by Brykczynski (2013). From Benner’s perspective, clinical wisdom was connected to the understanding of caring in general and to various aspects of nursing ethics. The concept primarily involves staying focused on the values of care delivery and aligning all the nursing practice activities with the general purpose of facilitating treatment and ensuring patient comfort. It is notable that, in this theoretical understanding, wisdom is linked to nursing ethics and is explained as the ability to follow ethical principles. All nursing practitioners are aware of the principles of nursing ethics; however, they may fail to follow those principles due to a variety of reasons, including lack of commitment and determination or pressure of the circumstances. Clinical wisdom can be seen as the ability to find a way to comply with nursing ethics and the values of caring in real-life situations.
Comparison to the Concept of Wisdom in Christian Writings
Based on the previous exploration of the concept of wisdom in the writings of Christian scholars in different periods of history, it can be said that the understanding of the concept in the modern nursing literature has more differences from the Christian understanding than similarities. Both understandings refer to wisdom as a positive quality and imply that wisdom is associated with knowing what to do and how to do it, but the visions of what constitutes wisdom are rather different for Christian scholars and nursing theorists. Many Christian scholars—during the Early Church Period, medieval times, and even the Age of Reason—identified wisdom with faith and claimed that a person is wise if he or she strictly complies with the religious rules found in the Bible. A more critical approach to the concept—for example, during the Reformation—suggested that wisdom was, in fact, not the same thing as faith or devotion to God and consisted of knowledge of God and knowledge of self.
Among modern nursing theorists, a similar understanding can be found in the article by Wiedenbach (1970). She argued that a nurse cannot display wisdom until the values of the profession are internalized, i.e. the author emphasized self-reflection as part of the effort to achieve wisdom. However, other major components of the Christian scholars’ understanding of wisdom were not found in modern nursing literature. While Christian writers often referred to wisdom as something that can be delivered to a person through revelations, nursing theorists stress the importance of experience and learning in achieving wisdom. While Christian writers discussed divine wisdom that cannot be comprehended by humans, nursing theorists were searching for ways to incorporate the concept of wisdom into nursing practice and explain what wise nurses do.
Implications from the Nursing Literature
Concept analysis allows building guidelines on how to use the concept of wisdom in enhancing the process of spiritual caregiving in advanced practice nursing. First of all, several implications for advanced practice nursing can be derived from the review of relevant nursing literature. The articles examined above suggest that wisdom in nursing should not be an abstract notion but should incorporate instructions on how to act wisely under clinical conditions. In this regard, a crucial process is the translation of theoretical concepts in nursing into actual practices. The wisdom-in-action approach proposed by Matney et al. (2016) suggests that nurses should commit to knowledge mastery, i.e. to applying the knowledge they have to their practice and constantly referring to evidence and confirmed practices. This implication of the theoretical understanding of wisdom complies with the widespread notion of evidence-based practice; in their work, nurses should show how their knowledge helps resolve issues in real-life clinical situations, and this behavior can be regarded as wise.
Another implication refers to the patient-centeredness of care. As Wiedenbach’s (1970) example described above shows, nurses’ wisdom can be manifested in the ability to resolve problem situations with patients more effectively. Indeed, the review of the literature suggests that wise nurses are those who pay much attention to the patient and find ways to ensure patient comfort and compliance with treatment. Brykczynski (2013) explains that being wise for a nurse means being committed to the values of caring in general. Therefore, wise nurses are those who are not distracted by their formal responsibilities and the routine of their work but stay committed to providing optimal care and complying with the ethical principles of autonomy, justice, beneficence, and nonmaleficence.
Finally, an important implication is that nurses should not be limited in their work to performing certain functions listed in their job descriptions only. Haggerty and Grace (2008) suggest that a crucial aspect of wise nursing is pursuing both the improvement of the state of a particular patient and the common good. The latter means that wisdom in advanced practice nursing means going beyond concrete care delivery plans and committing to bringing greater positive change. Wise nurses should realize that they can not only improve the health outcomes of a particular patient but also contribute to the improvement of the health situation in communities. This practice will help reduce the number of health problems among people who are not inpatients but still can be affected by the activities of a nursing care provider. For example, if a nurse is engaged in extensive patient education and delivery of practical advice, it is possible that the knowledge will be spread and will reach targets in the community before they have to go to a health care facility. Through engaging in patient education and community health programs, wise nurses can make remarkable contributions to preventing diseases and promoting healthy lifestyles.
Implications from the Historical Analysis
Concerning the analysis of the concept of wisdom in Christian scholars’ writings, it appears to be much more difficult to derive implications from them than from the modern nursing literature because Christian writers did not examine the concept specifically in the context of health care. However, some implications can still be derived; for example, St. Augustine described wisdom as the ability to tell true things from false ones and right things from wrong ones. In advanced practice nursing, this interpretation can be used to help practitioners recognize important aspects of their work and prioritize them. From this perspective, wisdom is about knowing what is more important (e.g. ensuring patient comfort and pursuing optimal patient outcomes) and what is less important (e.g. performing routine procedures, such as filing inpatient background information or generating supplementary documentation). Importantly, wisdom is not merely about knowing it but also about practicing the prioritization.
Further, nurses’ wisdom can be manifested in the way they manage to convince their colleagues, other members of the health care delivery team, or patients that a certain course of action is the wisest and the right one. St. John Chrysostom referred to the wisdom of Jesus Christ who managed to address to people in a very appealing way; similarly, a wise nurse is one who finds the most effective approach to whoever it is with whom he or she is interacting (another nurse, a physician, a health care facility administrator, or a patient). Based on the review of Christian literature, it can be said that wisdom is manifested in the ability to persuade people and appeal to them in a way that makes them reconsider their previous decisions. In this regard, wise nurses should be open in terms of listening to other people’s opinions but also consistent in terms of defending their positions and providing arguments and insistence in terms of promoting the course of action that they think is the best. Therefore, wisdom in nursing is associated with developing and improving communication skills that allow a nurse to persuade other people more effectively.
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Finally, the review of Christian scholars’ writings showed that theologians paid attention to the concept of wisdom as a necessity. For example, St. Thomas Aquinas thought that humans have the habit of wisdom that prompts them to search for the truth and makes it enjoyable for them to know the truth. To apply this idea to advanced practice nursing, practitioners should acknowledge that the desire to learn something new continuously is part of human nature and should be incorporated into the work of nurses. Continuous learning should become part of not only nursing education but also nursing practice. For example, the purpose of problem-solving should be seen as not only resolving a particular issue in a particular clinical situation but also having an opportunity to learn, develop a problem-solving strategy or technique, and apply it in the future. To be wise, nursing care providers should commit to learning constantly from any challenges they face in their practice.
I have researched the concept of wisdom in three domains: the Holy Bible, the writings of Christian scholars within the two millennia of the history of Christianity, and the modern nursing literature. First of all, the research helped me formulate with more precision what I mean when I say that I want to be a wise advanced practice nurse: it means that I want to know what to do in challenging situations and how to persuade others (patients, physicians, or other nurses). However, the research also revealed some aspects of wisdom that I had not thought about. For example, I have realized how difficult but important it is to comply with the principles you declare. Being wise is not only about knowing what the right thing to do is; it is also about finding ways to do it, demonstrating courage, and staying committed to the pivotal principles of delivering high-quality care.
I feel a little bit discouraged because of the understanding of wisdom as something that comes with extensive experience. One of the understandings of wisdom in the Old Testament is that it is something that can only be achieved after years of practice, and even the modern nursing literature suggests that age is one of the antecedents of wisdom. However, I do not think that the wisdom of a nurse can be measured in years of his or her experience solely. I believe that, in the process of delivering care, even young nurses can demonstrate wisdom if they can apply the knowledge they have, eager to learn, and committed to the values of pursuing optimal patient outcomes as well as the common good.
Brykczynski, K. A. (2013). Caring, clinical wisdom, and ethics in nursing practice. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed.) (pp. 120-146). St. Louis, MO: Elsevier.
Haggerty, L. A., & Grace, P. (2008). Clinical wisdom: The essential foundation of “good” nursing care. Journal of Professional Nursing, 24(4), 235-240.
Matney, S. A., Avant, K., & Staggers, N. (2016). Toward an understanding of wisdom in nursing. The Online Journal of Issues in Nursing, 21(1). Web.
McKie, A., Baguley, F., Guthrie, C., Jackson, C., Kirkpatrick, P., Laing, A., … Wimpenny, P. (2012). Exploring clinical wisdom in nursing education. Nursing Ethics, 19(2), 252-267.
Wiedenbach, E. (1970). Nurses’ wisdom in nursing theory. The American Journal of Nursing, 70(5), 1057-1062.